Provider Demographics
NPI:1780786012
Name:GARCIA-FRAGA, MARINA (MD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:GARCIA-FRAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7649 W COLONIAL DR STE 115
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7423
Mailing Address - Country:US
Mailing Address - Phone:407-533-2080
Mailing Address - Fax:833-963-0115
Practice Address - Street 1:7649 W COLONIAL DR STE 115
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7423
Practice Address - Country:US
Practice Address - Phone:407-533-2080
Practice Address - Fax:833-963-0115
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16016208D00000X
FLACN 408208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004129500Medicaid