Active NPI
Brandon Fresina
- Athletic Trainer
- Baton Rouge, LA
National Provider Identifier
1306228754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL5603
- Practice address
- 12617 Fairhaven Dr
Baton Rouge, LA 70815-6817 - Phone
- (225) 337-0021
- NPI assigned
- Jun 22, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL5603 | FL | Primary |
Addresses
Primary practice location
12617 Fairhaven Dr
Baton Rouge, LA 70815-6817
Mailing address
777 Glades Rd
Boca Raton, FL 33431-6496
Phone (225) 337-0021
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL5603 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594339200000",
"number": "1306228754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 GLADES RD",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334316496",
"telephone_number": "225-337-0021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12617 FAIRHAVEN DR",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708156817",
"telephone_number": "225-337-0021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRESINA",
"first_name": "BRANDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-22",
"last_updated": "2020-07-10",
"certification_date": "2020-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL5603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baton Rouge, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.