Provider Demographics
NPI:1720799745
Name:ARGUETA, FREDRICK JR (MEDICAL DRIVER)
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:
Last Name:ARGUETA
Suffix:JR
Gender:M
Credentials:MEDICAL DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3530
Mailing Address - Country:US
Mailing Address - Phone:505-803-2370
Mailing Address - Fax:
Practice Address - Street 1:2666 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3530
Practice Address - Country:US
Practice Address - Phone:505-803-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF4310521172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver