MEDICARE: CHARLEMAGNE BARROGA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F07190451	TX

General Provider Information

NPI Number	:	1265088256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLEMAGNE BARROGA FNP

Provider Business Mailing Address
First Line	:	915 S LAREDO ST
Second Line	:	STE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78204-3211
Country	:	US
Telephone Number	:	210-277-1418
Fax Number	:	210-798-1956

Provider Business Practice Location Address
First Line	:	915 S LAREDO ST
Second Line	:	STE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78204-3211
Country	:	US
Telephone Number	:	210-277-1418
Fax Number	:	210-798-1956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	08/14/2021

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