JUSTIN FREDERICKS DO
NPI 1487356176
General Practice in San Diego, CA

Q: What is Justin Fredericks's NPI number?

The NPI number for Justin Fredericks is 1487356176. It was assigned to this individual provider in the NPPES registry on March 20, 2023.

Q: What is Justin Fredericks's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Q: When was this NPI record last updated?

The NPPES record for Justin Fredericks was last updated on November 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 20, 2023PECOS Enrolled

2841 RENDOVA RD, SAN DIEGO, CA 92155(727) 742-6825 Get Directions Write a Review

NPPES record last updated: November 25, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Justin Fredericks Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JUSTIN FREDERICKS DO (NPI 1487356176) is an individual general practice provider in San Diego, California, licensed in Indiana (02007896A) and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1487356176

Entity TypeIndividualMale

Primary Taxonomy208D00000X

Provider Legal NameJUSTIN FREDERICKSCredential: DO

Location Address2841 RENDOVA RDSan Diego, CA 92155-5779

Mailing Address2841 Rendova RdSan Diego, CA 92155-5490 · (727) 742-6825

Phone(727) 742-6825

Sole ProprietorNo

Enumeration DateMarch 20, 2023

Last NPPES UpdateNovember 25, 2024

NPPES CertifiedNovember 25, 2024

✔ NPI 1487356176 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

License✔ Licensed in IN · 02007896A

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

2841 RENDOVA RD, San Diego, CA 92155

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Justin Fredericks Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOSHUA W. JOHNSON

Dentist