Provider Demographics
NPI:1891890059
Name:FRAGA PEDIATRICS & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:FRAGA PEDIATRICS & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-442-1740
Mailing Address - Street 1:7765 NW 48TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5404
Mailing Address - Country:US
Mailing Address - Phone:305-442-1740
Mailing Address - Fax:
Practice Address - Street 1:5590 W 20TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-7061
Practice Address - Country:US
Practice Address - Phone:305-828-3997
Practice Address - Fax:305-828-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000711900Medicaid
FL279232000Medicaid