Healthcare Provider Details

I. General information

NPI: 1225425549
Provider Name (Legal Business Name): LUIS ROLANDO FADRIGO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 NORTHPARK DR
KINGWOOD TX
77339-1636
US

IV. Provider business mailing address

24146 BLUE CREST DR
PORTER TX
77365
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-5330
  • Fax:
Mailing address:
  • Phone: 361-720-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP127655
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127655
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: