Provider Demographics
NPI:1720683246
Name:FRAUSTO, CARLOS DAVID (MSPA, PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:DAVID
Last Name:FRAUSTO
Suffix:
Gender:M
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1966
Mailing Address - Country:US
Mailing Address - Phone:951-538-6400
Mailing Address - Fax:
Practice Address - Street 1:2932 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1966
Practice Address - Country:US
Practice Address - Phone:951-538-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
CAPA58908363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant