Provider Demographics
NPI:1902836141
Name:FREI, KAREN PHYLLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:PHYLLIS
Last Name:FREI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6887 MANGO ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5320
Mailing Address - Country:US
Mailing Address - Phone:909-987-7838
Mailing Address - Fax:909-987-9838
Practice Address - Street 1:11370 ANDERSON ST # B-100
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-588-2880
Practice Address - Fax:909-558-2137
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG854922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0068549209Medicaid
CA0068549209Medicaid