Provider Demographics
NPI:1699583831
Name:BARRAGAN, FABIAN MATTHEW (PMNHP)
Entity type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:MATTHEW
Last Name:BARRAGAN
Suffix:
Gender:M
Credentials:PMNHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12519 TRIPLE CROWN AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-2270
Mailing Address - Country:US
Mailing Address - Phone:915-549-3946
Mailing Address - Fax:
Practice Address - Street 1:12519 TRIPLE CROWN AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-2270
Practice Address - Country:US
Practice Address - Phone:915-549-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182281363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health