Provider Demographics
NPI:1417026329
Name:FRINTNER, MARY L (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:FRINTNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 FOOTHILL BLVD
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2194
Mailing Address - Country:US
Mailing Address - Phone:818-952-1130
Mailing Address - Fax:
Practice Address - Street 1:1407 FOOTHILL BLVD
Practice Address - Street 2:SUITE # 2
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2194
Practice Address - Country:US
Practice Address - Phone:818-952-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1444237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0014440Medicaid
CAZZZ65341ZOtherBLUESHIELD PROVIDER NUM.
CAP00123882OtherRAILROAD MEDICARE
CAZZZ65341ZOtherBLUESHIELD PROVIDER NUM.