Provider Demographics
NPI:1982769733
Name:FROLOV, STEFAN JR (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:FROLOV
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 HEALTH CENTER DR
Mailing Address - Street 2:620
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3672
Mailing Address - Country:US
Mailing Address - Phone:949-452-3021
Mailing Address - Fax:949-455-1225
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:620
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3651
Practice Address - Country:US
Practice Address - Phone:949-452-3021
Practice Address - Fax:949-455-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27940OtherPTAN
CAG27940OtherPTAN