Provider Demographics
NPI:1619186129
Name:FRAGA, LINCOLN JOSE (LAC, DIPL OM, MAO)
Entity type:Individual
Prefix:MR
First Name:LINCOLN
Middle Name:JOSE
Last Name:FRAGA
Suffix:
Gender:M
Credentials:LAC, DIPL OM, MAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 CLARK AVE
Mailing Address - Street 2:STE. # 330
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2618
Mailing Address - Country:US
Mailing Address - Phone:562-925-0111
Mailing Address - Fax:562-925-5533
Practice Address - Street 1:5220 CLARK AVE
Practice Address - Street 2:STE. # 330
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2618
Practice Address - Country:US
Practice Address - Phone:562-925-0111
Practice Address - Fax:562-925-5533
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11494171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist