Provider Demographics
NPI:1023051588
Name:FRAZER, GREGORY JAMES (AUD , PHD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:FRAZER
Suffix:
Gender:M
Credentials:AUD , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE# 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-477-5558
Mailing Address - Fax:310-477-7281
Practice Address - Street 1:11645 WILSHIRE BLVD STE 601A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-909-0180
Practice Address - Fax:310-919-3181
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU651174400000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0006510Medicaid
CAR14133Medicare UPIN
CAAU0006510Medicaid
CAAUD651Medicare PIN