Organization
GUILLERMO FRAGA, M.D. A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUILLERMO HUGO FRAGA M.D. (PHYSICIAN)
(702) 452-3002
Entity
Organization
Contact information
Practice address
2649 WIGWAM PKWY, SUITE 100, HENDERSON, NV 89074-7310
(702) 452-3002
Mailing address
2649 WIGWAM PKWY, SUITE 100, HENDERSON, NV 89074-7310
(702) 452-3002
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
7867
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002019808
—
NV
01
—
101047
GROUP PIN
NV
01
—
NV02663
MEDICARE EDI
NV
Enumeration date
10/03/2007
Last updated
10/03/2007
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