Provider Demographics
NPI:1699396259
Name:FRAGOSO, NESTOR GABRIEL (CF-SLP)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:GABRIEL
Last Name:FRAGOSO
Suffix:
Gender:M
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 17TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1922
Mailing Address - Country:US
Mailing Address - Phone:408-504-3031
Mailing Address - Fax:
Practice Address - Street 1:AUDIOLOGY/SPEECH PATHOLOGY SERVICE (126)
Practice Address - Street 2:3801 MIRANDA AVENUE
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist