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General NPI Number Information
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NPI Number | 1447251285
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Entity Type | Individual
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Provider Name | ANGEL LUIS FRAGUADA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 611 CALLE PAVIA SUITE 112
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City | SANTURCE
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State | PR
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Zip | 00909-2239
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Country | US
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Telephone | 787-728-9849
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Fax | 787-268-5366
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Provider Business Mailing Address
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Address Line | SE25 CAMINO DE LA ZARZUELA MANSION DEL SUR
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City | TOA BAJA
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State | PR
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Zip | 00949-4827
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Country | US
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Telephone | 787-784-2210
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Fax | 787-795-6843
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 8776
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License Number State | PR
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