Basic Information
| Provider Information | |||||||||
| NPI: | 1306383385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAZER | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38414 CHERRY VALLEY BLVD | ||||||||
| Address2: | |||||||||
| City: | CHERRY VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922234120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094331080 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2220 GIRARD ST | ||||||||
| Address2: | |||||||||
| City: | SAN JACINTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925835301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519258450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2017 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.