Provider Demographics
NPI:1851832976
Name:FRAZEE, JENNIFER GALICIA (MENTAL HEALTH REHAB)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GALICIA
Last Name:FRAZEE
Suffix:
Gender:F
Credentials:MENTAL HEALTH REHAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CENTERPOINTE DR STE 700
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2545
Mailing Address - Country:US
Mailing Address - Phone:818-404-4997
Mailing Address - Fax:
Practice Address - Street 1:900 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4630
Practice Address - Country:US
Practice Address - Phone:818-404-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 225400000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker