Healthcare Provider Details

I. General information

NPI: 1679486823
Provider Name (Legal Business Name): MILAGROS DEL VALLE FRAGOSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 COMMERCE DR STE 208
CARMEL IN
46032-7433
US

IV. Provider business mailing address

11556 WALTON CRES
ZIONSVILLE IN
46077-7022
US

V. Phone/Fax

Practice location:
  • Phone: 317-702-0765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number71018418A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: