Provider Demographics
NPI:1174219471
Name:FRANGOS, EDEN D
Entity type:Individual
Prefix:MS
First Name:EDEN
Middle Name:D
Last Name:FRANGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EDEN
Other - Middle Name:D
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-7462
Mailing Address - Fax:
Practice Address - Street 1:1607 KYLE DAYTON DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-6758
Practice Address - Country:US
Practice Address - Phone:510-755-8895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician