Individual
DR. JACINTO THOMAS FRAGOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUD
Contact information
Practice address
1115 RONALD REAGAN PKWY STE 254, AVON, IN 46123-6911
(317) 944-6467
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
1601000873
MI
231H00000X
Audiologist
Primary
23002773A
IN
231H00000X
Audiologist
A.02322
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
063220089
MEDICARE
IN
05
—
300071172
—
IN
Enumeration date
06/22/2020
Last updated
03/14/2023
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