Basic Information
| Provider Information | |||||||||
| NPI: | 1639119274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRYE | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 NEWPORT BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926273786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772778271 | ||||||||
| FaxNumber: | 9497066356 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 NEWPORT BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926273786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773780401 | ||||||||
| FaxNumber: | 9497066356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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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 | 2085R0202X | G79577 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME119366 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 01 | FL | MEDICARE | OTHER | 013321800 | 05 | FL | MEDICAID |