Provider Demographics
NPI:1275054827
Name:FRAGOSO, SAMARIZ (OT)
Entity type:Individual
Prefix:
First Name:SAMARIZ
Middle Name:
Last Name:FRAGOSO
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA NEVAREZ
Mailing Address - Street 2:1079 CALLE 8
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:939-988-7298
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO 3077 PR 838 KM 1.5
Practice Address - Street 2:CAMINO ALEJANDRINO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4800
Practice Address - Country:US
Practice Address - Phone:787-409-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR925-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist