Provider Demographics
NPI:1831505809
Name:CURTIS, FREDERICK (PA)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2227
Mailing Address - Country:US
Mailing Address - Phone:415-683-8514
Mailing Address - Fax:
Practice Address - Street 1:23500 KASSON RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95378
Practice Address - Country:US
Practice Address - Phone:209-835-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant