Individual
GAIL JUNE FREDERICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
121 DIANA ST, PLACERVILLE, CA 95667-3313
(530) 559-2880
(530) 622-2979
Mailing address
121 DIANA ST, PLACERVILLE, CA 95667-3313
(530) 559-2880
(530) 622-2979
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A61646
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A616460
—
CA
01
—
05D0932276
CLIA ID NO
CA
Enumeration date
10/06/2006
Last updated
03/07/2023
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