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General NPI Number Information
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NPI Number | 1104809433
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Entity Type | Individual
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Provider Name | GUILLERMO FRAGA MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 2610 W. HORIZON PKWY. SUITE 105
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City | HENDERSON
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State | NV
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Zip | 89052
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Country | US
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Telephone | 702-724-8777
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Fax | 702-724-8749
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-724-8777
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Fax | 702-724-8749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 7867
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License Number State | NV
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