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General NPI Number Information
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NPI Number | 1679196695
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Entity Type | Individual
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Provider Name | LEOSVEL FRAGA
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Gender | Male
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 300 PINELLAS ST
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City | CLEARWATER
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State | FL
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Zip | 33756-3804
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Country | US
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Telephone | 813-870-4015
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Fax | 813-605-6269
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Provider Business Mailing Address
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Address Line | 2995 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7496
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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 | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA594
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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