NPIMap

Organization Active NPI

Guillermo Fraga, M.D. a Professional Corporation

  • Primary Care Clinic/Center
  • Henderson, NV
National Provider Identifier
1992992978
Registry record updated Oct 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
7867 Issued in NV
Legal business name
GUILLERMO FRAGA, M.D. A PROFESSIONAL CORPORATION
Practice address
2649 Wigwam Pkwy
Suite 100
Henderson, NV 89074-7310
Phone
(702) 452-3002
NPI assigned
Oct 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Guillermo Hugo Fraga, M.D.NPI 1104809433
Title
Physician
Phone
(702) 452-3002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 7867 NV Primary

Addresses

Primary practice location

2649 Wigwam Pkwy
Suite 100
Henderson, NV 89074-7310

Mailing address

2649 Wigwam Pkwy
Suite 100
Henderson, NV 89074-7310
Phone (702) 452-3002

Other identifiers 3

IdentifierTypeStateIssuer
NV02663OtherNVMEDICARE EDI
002019808MedicaidNV
101047OtherNVGROUP PIN

National Provider Directory

National Provider Directory

Locations

2649 Wigwam Pkwy
Ste 100
Henderson, NV 89074
Phone (702) 452-3002

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1992992978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2649 WIGWAM PKWY",
            "address_2": "SUITE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747310",
            "telephone_number": "702-452-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2649 WIGWAM PKWY",
            "address_2": "SUITE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747310",
            "telephone_number": "702-452-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUILLERMO FRAGA, M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-03",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "FRAGA",
        "authorized_official_first_name": "GUILLERMO",
        "authorized_official_middle_name": "HUGO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "702-452-3002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NV",
            "license": "7867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE EDI",
            "identifier": "NV02663",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002019808",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PIN",
            "identifier": "101047",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.