Provider Demographics
NPI:1417154436
Name:FRAGOSO, RUBEN CORRAL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:CORRAL
Last Name:FRAGOSO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:854 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-4039
Mailing Address - Country:US
Mailing Address - Phone:617-869-4409
Mailing Address - Fax:916-703-5069
Practice Address - Street 1:4501 X ST
Practice Address - Street 2:SUITE 0156
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2229
Practice Address - Country:US
Practice Address - Phone:916-734-8276
Practice Address - Fax:916-703-5069
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1871292085R0001X
CAA1092592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology