Individual
DANAE FREDERICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2001 SANTA MONICA BLVD STE 680W, SANTA MONICA, CA 90404-2111
(310) 829-8928
Mailing address
2001 SANTA MONICA BLVD STE 680W, SANTA MONICA, CA 90404-2111
(310) 829-8928
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
26279
CA
363A00000X
Physician Assistant
Primary
58585
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26279
DENTAL HYGIENE COMMITTEE OF CALIFORNIA
CA
Enumeration date
10/20/2016
Last updated
12/17/2024
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