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General NPI Number Information
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NPI Number | 1992992978
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Entity Type | Organization
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Legal Business Name | GUILLERMO FRAGA, M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 2649 WIGWAM PKWY SUITE 100
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City | HENDERSON
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State | NV
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Zip | 89074-7310
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Country | US
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Telephone | 702-452-3002
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Fax |
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Provider Business Mailing Address
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Address Line | 2649 WIGWAM PKWY SUITE 100
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City | HENDERSON
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State | NV
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Zip | 89074-7310
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Country | US
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Telephone | 702-452-3002
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GUILLERMO HUGO FRAGA
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Credential | M.D.
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Telephone | 702-452-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 7867
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License Number State | NV
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