Provider Demographics
NPI:1922005297
Name:FREY, JANE H (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:H
Last Name:FREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 VAN NUYS BLVD
Mailing Address - Street 2:STE 215
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2146
Mailing Address - Country:US
Mailing Address - Phone:818-995-3132
Mailing Address - Fax:818-995-1381
Practice Address - Street 1:4835 VAN NUYS BLVD
Practice Address - Street 2:STE 215
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2146
Practice Address - Country:US
Practice Address - Phone:818-995-3132
Practice Address - Fax:818-995-1381
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G515330Medicaid
CA00G515330Medicaid
CAA93076Medicare UPIN