Healthcare Provider Details

I. General information

NPI: 1932010444
Provider Name (Legal Business Name): ROSA FRAGELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 TOURMALINE ST APT 9
SAN DIEGO CA
92109-1745
US

IV. Provider business mailing address

812 TOURMALINE ST APT 9
SAN DIEGO CA
92109-1745
US

V. Phone/Fax

Practice location:
  • Phone: 724-858-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: