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Individual

MARY L FAGARAGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
687 BEVILLE RD STE A, SOUTH DAYTONA, FL 32119-1970
(386) 871-4781
(386) 761-5868
Mailing address
687 BEVILLE RD STE A, SOUTH DAYTONA, FL 32119-1970
(386) 871-4781
(386) 761-5868

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104854300
FL
Enumeration date
09/23/2019
Last updated
12/14/2023
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