Provider Demographics
NPI:1851488316
Name:FRADIN-READ, DOMINIQUE M (MD,MPH)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:M
Last Name:FRADIN-READ
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5935 PLAYA VISTA DR
Mailing Address - Street 2:#415
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2130
Mailing Address - Country:US
Mailing Address - Phone:818-406-1939
Mailing Address - Fax:310-745-1944
Practice Address - Street 1:12301 WILSHIRE BLVD
Practice Address - Street 2:#315 VITALIFE-MD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1007
Practice Address - Country:US
Practice Address - Phone:424-325-3368
Practice Address - Fax:424-288-5506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2015-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA92155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist