Individual
JUSTIN FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2841 RENDOVA RD, SAN DIEGO, CA 92155-5779
(727) 742-6825
Mailing address
2841 RENDOVA RD, SAN DIEGO, CA 92155-5490
(727) 742-6825
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
02007896A
IN
Other
Enumeration date
03/20/2023
Last updated
11/25/2024
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