Individual provider Active NPI

Aliya L. Frederick, MD, PHD

  • Neurology with Special Qualifications in Child Neurology Physician
  • San Diego, CA
National Provider Identifier
1548657992
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
A148160 Issued in CA
Practice address
8001 Frost St
San Diego, CA 92123-2746
Phone
(858) 966-5819
NPI assigned
Apr 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X A148160 CA Primary
Clinical Neurophysiology Physician 2084N0600X A148160 CA

Addresses

Primary practice location

8001 Frost St
San Diego, CA 92123-2746

Mailing address

3020 Childrens Way # Mc5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210720002178 CA Practitioner - Neurology 1850794454 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
A148160CAMDClinical Neurophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jul 1, 2021 Accepting new patients
Regents of the University of California Neurology CurrentSince Jul 1, 2021 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation PastSince Apr 11, 2021 Accepting new patients

Locations

9350 Campus Point Dr
La Jolla, CA 92037
Phone (858) 657-0583

8001 Frost St
San Diego, CA 92123
Phone (858) 966-5819

4250 1st Ave
San Diego, CA 92103
Phone (415) 290-8175

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

7910 Frost St
Ste 230
San Diego, CA 92123
Phone (858) 246-0053

3020 Childrens Way
#5003
San Diego, CA 92123
Phone (858) 309-6300

3020 Childrens Way
#5124
San Diego, CA 92123
Phone (858) 966-6764

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

Interoperability endpoints

  • Direct secure messaging: afrederick181536@radychildrens.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1548657992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 FROST ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232746",
            "telephone_number": "858-966-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICK",
        "first_name": "ALIYA",
        "middle_name": "L.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-23",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "CA",
            "license": "A148160",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "CA",
            "license": "A148160",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.