Provider Demographics
NPI:1790832129
Name:FRAUSTO, MANUEL J (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:J
Last Name:FRAUSTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 INSPIRATION WAY
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2519
Mailing Address - Country:US
Mailing Address - Phone:830-775-2049
Mailing Address - Fax:830-775-7325
Practice Address - Street 1:1117 W DE LA ROSA ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-6224
Practice Address - Country:US
Practice Address - Phone:830-768-4800
Practice Address - Fax:830-768-4844
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE7401208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22780Medicare UPIN