Bruce Robert Fredenburg, L.M.F.T.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC17319 Issued in CA

Practice address

17542 Irvine Blvd
Suite F
Tustin, CA 92780-3155

Phone

(714) 508-1919

Fax

(714) 508-1935

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104833938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 808",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926290808",
            "telephone_number": "949-338-2218",
            "fax_number": "949-855-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17542 IRVINE BLVD",
            "address_2": "SUITE F",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803155",
            "telephone_number": "714-508-1919",
            "fax_number": "714-508-1935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDENBURG",
        "first_name": "BRUCE",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "L.M.F.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC17319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Tustin, CA
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.