Individual
EDGAR FRAGOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
1300 CASTLE CT, HOUSTON, TX 77006-5702
(210) 859-5438
Mailing address
PO BOX 667090, HOUSTON, TX 77266-7090
(210) 859-5438
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
SA00305
TX
363AS0400X
Surgical Physician Assistant
Primary
SA00305
TX
Other
Enumeration date
01/22/2008
Last updated
09/08/2024
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