Provider Demographics
NPI:1881768026
Name:FRID, GERMAINE JOAN (MD)
Entity type:Individual
Prefix:MRS
First Name:GERMAINE
Middle Name:JOAN
Last Name:FRID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:BORIS
Other - Last Name:FRID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1100 N PALM CANYON DR
Mailing Address - Street 2:111
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4414
Mailing Address - Country:US
Mailing Address - Phone:760-325-6530
Mailing Address - Fax:760-325-7866
Practice Address - Street 1:1100 N PALM CANYON DR
Practice Address - Street 2:111
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4414
Practice Address - Country:US
Practice Address - Phone:760-325-6530
Practice Address - Fax:760-325-7866
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6891207Q00000X
CAA37057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28281Medicare UPIN
CAG79803Medicare UPIN