Provider Demographics
NPI:1104614056
Name:FRAIRE, MYJORNAE
Entity type:Individual
Prefix:MRS
First Name:MYJORNAE
Middle Name:
Last Name:FRAIRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15801 MALPAIS LN
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1828
Mailing Address - Country:US
Mailing Address - Phone:951-722-0267
Mailing Address - Fax:
Practice Address - Street 1:15801 MALPAIS LN
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1828
Practice Address - Country:US
Practice Address - Phone:951-722-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula