Provider Demographics
NPI:1811911027
Name:ARCE FRAGA, MARIA D (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:ARCE FRAGA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 AVE ASHFORD APT 607
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1020
Mailing Address - Country:US
Mailing Address - Phone:787-234-8987
Mailing Address - Fax:
Practice Address - Street 1:107 AVE ORTEGON STE 307
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2520
Practice Address - Country:US
Practice Address - Phone:787-234-8987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-1399FMedicare ID - Type Unspecified