Provider Demographics
NPI:1265424881
Name:FRAGA, ENRIQUE Z (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:Z
Last Name:FRAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:FRAGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2300 W 84TH ST
Mailing Address - Street 2:501
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5770
Mailing Address - Country:US
Mailing Address - Phone:305-273-5511
Mailing Address - Fax:305-273-5511
Practice Address - Street 1:2300 WEST 84 ST
Practice Address - Street 2:SUITE 501
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33016-1029
Practice Address - Country:US
Practice Address - Phone:305-273-5511
Practice Address - Fax:305-273-6622
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0046427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374240700Medicaid
FL117431500Medicaid
FL374240700Medicaid