Healthcare Provider Details

I. General information

NPI: 1265424881
Provider Name (Legal Business Name): ENRIQUE Z FRAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICK FRAGA MD

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WEST 84 ST SUITE 501
MIAMI FL
33016-1029
US

IV. Provider business mailing address

2300 W 84TH ST 501
HIALEAH FL
33016-5770
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-5511
  • Fax: 305-273-6622
Mailing address:
  • Phone: 305-273-5511
  • Fax: 305-273-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0046427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: