Healthcare Provider Details

I. General information

NPI: 1437446374
Provider Name (Legal Business Name): HELEN V. FRAGUA PA-C,MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 JACKIE RD SE SUITE 101
RIO RANCHO NM
87124-1519
US

IV. Provider business mailing address

1350 JACKIE RD SE SUITE 101
RIO RANCHO NM
87124-1519
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-7518
  • Fax: 505-892-9092
Mailing address:
  • Phone: 505-892-7518
  • Fax: 505-892-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number97-PA14
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: