Provider Demographics
NPI:1437357209
Name:HERNANDEZ FRAGOSO, IGNACIO (MD)
Entity Type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:
Last Name:HERNANDEZ FRAGOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1286
Mailing Address - Country:US
Mailing Address - Phone:787-860-7448
Mailing Address - Fax:787-285-7513
Practice Address - Street 1:B ST C-7 URB MELENDEZ
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-1286
Practice Address - Country:US
Practice Address - Phone:787-860-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36722083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine