Provider Demographics
NPI:1437446374
Name:FRAGUA, HELEN V (PA-C,MSN)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:V
Last Name:FRAGUA
Suffix:
Gender:F
Credentials:PA-C,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 JACKIE RD SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1519
Mailing Address - Country:US
Mailing Address - Phone:505-892-7518
Mailing Address - Fax:505-892-9092
Practice Address - Street 1:1350 JACKIE RD SE
Practice Address - Street 2:SUITE 101
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1519
Practice Address - Country:US
Practice Address - Phone:505-892-7518
Practice Address - Fax:505-892-9092
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-PA14363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical