Provider Demographics
NPI:1841861390
Name:FERNANDEZ-FRAGA, OLGUYNE (RD)
Entity type:Individual
Prefix:
First Name:OLGUYNE
Middle Name:
Last Name:FERNANDEZ-FRAGA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4605
Mailing Address - Country:US
Mailing Address - Phone:786-205-7586
Mailing Address - Fax:786-822-5533
Practice Address - Street 1:7145 SW 42ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4605
Practice Address - Country:US
Practice Address - Phone:786-377-4740
Practice Address - Fax:786-822-5533
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9455133N00000X, 133VN1004X, 133VN1201X, 133VN1301X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology