Healthcare Provider Details

I. General information

NPI: 1891890059
Provider Name (Legal Business Name): FRAGA PEDIATRICS & ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5590 W 20TH AVE STE 100
HIALEAH FL
33016-7061
US

IV. Provider business mailing address

7765 NW 48TH ST STE 300
DORAL FL
33166-5404
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-3997
  • Fax: 305-828-4696
Mailing address:
  • Phone: 305-442-1740
  • Fax:

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: RENE CASANOVA
Title or Position: PRESIDENT
Credential:
Phone: 305-442-1740