Healthcare Provider Details

I. General information

NPI: 1932204179
Provider Name (Legal Business Name): LAZARO FRAGA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SW 6TH ST
CORAL GABLES FL
33134-2057
US

IV. Provider business mailing address

PO BOX 351597
MIAMI FL
33135-7597
US

V. Phone/Fax

Practice location:
  • Phone: 305-443-5031
  • Fax: 305-442-0844
Mailing address:
  • Phone: 305-443-5063
  • Fax: 305-443-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NORKI HUERTAS
Title or Position: PRESIDENT
Credential:
Phone: 305-443-5063