MEDICARE: DR. OLGA VICTORIA FRAGA 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	208000000X	Pediatrics Physician	ME0102288	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982800769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA VICTORIA FRAGA M.D.

Provider Business Mailing Address
First Line	:	13770 PLANTATION RD STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4460
Country	:	US
Telephone Number	:	239-689-5561
Fax Number	:	239-689-5958

Provider Business Practice Location Address
First Line	:	13770 PLANTATION RD STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4460
Country	:	US
Telephone Number	:	239-689-5561
Fax Number	:	239-689-5958

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	04/13/2021

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