Individual provider Active NPI

Frenz Dave Malic Delfin, FNP-C

  • Family Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1841952520
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95019400 Issued in CA
Practice address
808 W 55TH St
Los Angeles, CA 90037-3620
Phone
(323) 541-1411
NPI assigned
Oct 9, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Registered Nurse 163WR0400X R108241 AR
Family Nurse Practitioner 363LF0000X 95019400 CA Primary

Addresses

Primary practice location

808 W 55TH St
Los Angeles, CA 90037-3620

Mailing address

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1600

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220928003425 CA Practitioner - Nurse Practitioner 3476939406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John's Community HealthGroup PAC ID 2961482690, 151 clinicians

Practice addresses (Care Compare)

1910 Magnolia Ave
Suite 101
Los Angeles, CA 90007-1220
Phone (213) 749-0947

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R108241ARMDRehabilitation Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St. Johns Community Health CurrentSince Jun 17, 2022 Accepting new patients
St. Johns Community Health Current Accepting new patients
St. Johns Community Health CurrentSince Jun 17, 2022 Accepting new patients
St. Johns Community Health Past Accepting new patients

Locations

2115 N Wilmington Ave
Compton, CA 90222
Phone (310) 603-1332

1910 Magnolia Ave
Ste 101
Los Angeles, CA 90007

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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": "1633737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1841952520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W 55TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373620",
            "telephone_number": "323-541-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELFIN",
        "first_name": "FRENZ DAVE",
        "middle_name": "MALIC",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-09",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WR0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Rehabilitation",
            "state": "AR",
            "license": "R108241",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95019400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.