Healthcare Provider Details

I. General information

NPI: 1891313250
Provider Name (Legal Business Name): ERIK JULIEN FRAGOSO M.S., AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 10/15/2024
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

IV. Provider business mailing address

PO BOX 72
PICO RIVERA CA
90660-0072
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4545
  • Fax:
Mailing address:
  • Phone: 323-697-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: