Provider Demographics
NPI:1255709838
Name:ALEX FRIDMAN MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALEX FRIDMAN MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:213-864-4615
Mailing Address - Street 1:5334 LINDLEY AVE UNIT 222
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2905
Mailing Address - Country:US
Mailing Address - Phone:213-864-4615
Mailing Address - Fax:818-357-2171
Practice Address - Street 1:948 N FAIRFAX AVE STE 201
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-7204
Practice Address - Country:US
Practice Address - Phone:323-654-2020
Practice Address - Fax:323-654-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103675281P00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No281P00000XHospitalsChronic Disease Hospital