Provider Demographics
NPI:1689265746
Name:FRAIJO, ANASTACIA YVONNE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:YVONNE
Last Name:FRAIJO
Suffix:
Gender:F
Credentials:LAT, ATC
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 1719
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-1719
Mailing Address - Country:US
Mailing Address - Phone:559-288-6902
Mailing Address - Fax:
Practice Address - Street 1:208 EDGEMONT BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2320
Practice Address - Country:US
Practice Address - Phone:559-288-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00014852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer