Provider Demographics
NPI:1578541124
Name:FRAUSTO, MARCELLA A (MD)
Entity Type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:A
Last Name:FRAUSTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 MONTWOOD DR
Mailing Address - Street 2:STE 300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5694
Mailing Address - Country:US
Mailing Address - Phone:915-849-9733
Mailing Address - Fax:
Practice Address - Street 1:12350 MONTWOOD DR
Practice Address - Street 2:STE 300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5694
Practice Address - Country:US
Practice Address - Phone:915-849-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1576208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1576OtherLICENSE