Provider Demographics
NPI:1447311261
Name:FRIEDLINE, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:FRIEDLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2408
Mailing Address - Country:US
Mailing Address - Phone:760-344-8100
Mailing Address - Fax:760-545-0243
Practice Address - Street 1:1550 PEPPER DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4165
Practice Address - Country:US
Practice Address - Phone:760-312-5900
Practice Address - Fax:866-493-3117
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036871207Q00000X
CAG146705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA126737OtherLABOR & INDUSTRIES
WAAB08714Medicare ID - Type Unspecified
WA126737OtherLABOR & INDUSTRIES