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General NPI Number Information
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NPI Number | 1225425549
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Entity Type | Individual
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Provider Name | LUIS ROLANDO FADRIGO JR.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 1331 NORTHPARK DR
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City | KINGWOOD
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State | TX
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Zip | 77339-1636
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Country | US
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Telephone | 281-359-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 24146 BLUE CREST DR
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City | PORTER
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State | TX
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Zip | 77365
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Country | US
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Telephone | 361-720-1310
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Fax |
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | AP127655
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP127655
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License Number State | TX
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