Provider Demographics
NPI:1447251285
Name:FRAGUADA, ANGEL LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:FRAGUADA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:SE25 CAMINO DE LA ZARZUELA
Mailing Address - Street 2:MANSION DEL SUR
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4827
Mailing Address - Country:US
Mailing Address - Phone:787-784-2210
Mailing Address - Fax:787-795-6843
Practice Address - Street 1:611 CALLE PAVIA
Practice Address - Street 2:SUITE 112
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2239
Practice Address - Country:US
Practice Address - Phone:787-728-9849
Practice Address - Fax:787-268-5366
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2013-08-07
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Provider Licenses
StateLicense IDTaxonomies
PR8776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82541Medicare ID - Type Unspecified
PRF03992Medicare UPIN