Michael Robert Frederiksen, 101YA0400X

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

500 W Hospital Rd
French Camp, CA 95231-9693

Phone

(209) 468-6857

NPI assigned

Oct 18, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1609419951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021552",
            "telephone_number": "209-468-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W HOSPITAL RD",
            "city": "FRENCH CAMP",
            "state": "CA",
            "postal_code": "952319693",
            "telephone_number": "209-468-6857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERIKSEN",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "credential": "101YA0400X",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-18",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": "10139",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria G. Formoso, M.D.
• Rick Fox, CRNA
• Francisco Franco
• Tracey Franco
• Brittany Nichelle Franklin
• Ma Leanza Louise Buela Fronda, MD
• Claudia Fuentes
• Kenya Monique Fuller
• G.L.O.M.
• G.O.a.L.S Success Pad Inc

• Addiction (Substance Use Disorder) Counselor in French Camp, CA
• Providers in French Camp, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.