MEDICARE: MS. MARCELLA A FRAUSTO MD

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	208000000X	Pediatrics Physician	L1576	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L1576	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1578541124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCELLA A FRAUSTO MD

Provider Business Mailing Address
First Line	:	12350 MONTWOOD DR
Second Line	:	STE 300
City	:	EL PASO
State	:	TX
Zip	:	79928-5694
Country	:	US
Telephone Number	:	915-849-9733
Fax Number	:

Provider Business Practice Location Address
First Line	:	12350 MONTWOOD DR
Second Line	:	STE 300
City	:	EL PASO
State	:	TX
Zip	:	79928-5694
Country	:	US
Telephone Number	:	915-849-9733
Fax Number	:

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	02/06/2014

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