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NPI Code Detail

MEDICARE: JOSE MONTENEGRO FRAGOSO

MEDICARE: JOSE MONTENEGRO FRAGOSO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-15-18980TX

General Provider Information

NPI Number : 1528527462
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE MONTENEGRO FRAGOSO
Provider Business Mailing Address
First Line : 1055 E COLORADO BLVD STE 560
Second Line :
City : PASADENA
State : CA
Zip : 91106-2380
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5400 SUNCREST DR STE D1
Second Line :
City : EL PASO
State : TX
Zip : 79912-5615
Country : US
Telephone Number : 818-241-6780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2019
Last Update Date : 08/15/2019

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Directions to “ JOSE MONTENEGRO FRAGOSO ” Practice Location

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