Provider Demographics
NPI:1649330101
Name:FRATIANNI, SALVATORE (DO)
Entity type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:FRATIANNI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SEARIDGE RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-689-9600
Mailing Address - Fax:831-689-9663
Practice Address - Street 1:245 SEARIDGE RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-689-9600
Practice Address - Fax:831-689-9663
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27662Medicare UPIN
020A67040Medicare ID - Type Unspecified