Basic Information
| Provider Information | |||||||||
| NPI: | 1174595144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRAKES | ||||||||
| FirstName: | LAURIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 477 N EL CAMINO REAL | ||||||||
| Address2: | STE D200 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920241328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604523340 | ||||||||
| FaxNumber: | 7604523344 | ||||||||
| Practice Location | |||||||||
| Address1: | 477 N EL CAMINO REAL | ||||||||
| Address2: | STE D200 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920241328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604523340 | ||||||||
| FaxNumber: | 7604523344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | A52663 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | A52663 | 05 | AR | MEDICAID |