Provider Demographics
NPI:1184892135
Name:FRALEY, CHARLES FREDERICK III (DO)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:FRALEY
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:28780 SINGLE OAK DR., SUITE 160
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5528
Mailing Address - Country:US
Mailing Address - Phone:951-676-4193
Mailing Address - Fax:951-719-1469
Practice Address - Street 1:41011 CALIFORNIA OAKS RD STE 103
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5751
Practice Address - Country:US
Practice Address - Phone:951-676-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA9721207Q00000X
CA20A9721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTH000Medicare UPIN
CA020A97210Medicare PIN