Basic Information
| Provider Information | |||||||||
| NPI: | 1124518501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAGOSO REYES | ||||||||
| FirstName: | FRANCISCO | ||||||||
| MiddleName: | EMMANUEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9809 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007269809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875165165 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | B5 AVE GAUTIER BENITEZ ANEXO | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877447444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2018 | ||||||||
| LastUpdateDate: | 05/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 85314 | PR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.