Healthcare Provider Details

I. General information

NPI: 1316228729
Provider Name (Legal Business Name): KAREN KAY GRAGASIN ALFONSO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 POMONA RINCON RD
CHINO HILLS CA
91709-5572
US

IV. Provider business mailing address

15855 POMONA RINCON RD
CHINO HILLS CA
91709-5572
US

V. Phone/Fax

Practice location:
  • Phone: 909-929-2511
  • Fax:
Mailing address:
  • Phone: 909-929-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA119750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: