MEDICARE: DR. ANGEL LUIS FRAGUADA M.D.

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	207V00000X	Obstetrics & Gynecology Physician	8776	PR

General Provider Information

NPI Number	:	1447251285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGEL LUIS FRAGUADA M.D.

Provider Business Mailing Address
First Line	:	SE25 CAMINO DE LA ZARZUELA
Second Line	:	MANSION DEL SUR
City	:	TOA BAJA
State	:	PR
Zip	:	00949-4827
Country	:	US
Telephone Number	:	787-784-2210
Fax Number	:	787-795-6843

Provider Business Practice Location Address
First Line	:	611 CALLE PAVIA
Second Line	:	SUITE 112
City	:	SANTURCE
State	:	PR
Zip	:	00909-2239
Country	:	US
Telephone Number	:	787-728-9849
Fax Number	:	787-268-5366

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/07/2013

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