Individual
ELISSA FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11196 SARATOGA DR, LOS ALAMITOS, CA 90720-2640
(714) 975-1236
Mailing address
11196 SARATOGA DR, LOS ALAMITOS, CA 90720-2640
(714) 975-1236
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
594675
CA
Other
Enumeration date
01/15/2021
Last updated
01/15/2021
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