Provider Demographics
NPI:1720159965
Name:FRAGA, CARLOS J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:FRAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PASEO SAN PABLO
Mailing Address - Street 2:A CADILLA BLG STE 406
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7019
Mailing Address - Country:US
Mailing Address - Phone:787-798-4989
Mailing Address - Fax:787-798-4988
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:A CADILLA BLG STE 406
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-798-4989
Practice Address - Fax:787-798-4988
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10579207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF54668Medicare UPIN