Individual provider Active NPI

Obed Fraser, PA-C, MPAS

  • Physician Assistant
  • Long Beach, CA
National Provider Identifier
1073092714
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
55827 Issued in CA
Practice address
320 Pine Ave Ste 609
Long Beach, CA 90802-2310
Phone
(270) 792-7190
NPI assigned
Aug 13, 2018
Last updated
Aug 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 55827 CA Primary

Addresses

Primary practice location

320 Pine Ave Ste 609
Long Beach, CA 90802-2310

Mailing address

320 Pine Ave Ste 609
Long Beach, CA 90802-2310
Phone (270) 792-7190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1073092714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 PINE AVE STE 609",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908022310",
            "telephone_number": "270-792-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 PINE AVE STE 609",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908022310",
            "telephone_number": "270-792-7190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "OBED",
        "name_prefix": "Mr.",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-13",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.