Basic Information
| Provider Information | |||||||||
| NPI: | 1447222955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRITOCK | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | DE LOS ANGELES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 WILSHIRE BLVD STE 600 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900102814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233613550 | ||||||||
| FaxNumber: | 3233618052 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 1ST ST SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072842511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 102165 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2009-00448 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 48273 | MN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | C155002 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 373104900 | 05 | MN | MEDICAID | 35225300 | 05 | WI | MEDICAID | P01011923 | 01 | MN | RAILROAD - MEDICARE | OTHER | ENROLLED | 05 | IA | MEDICAID |