Healthcare Provider Details

I. General information

NPI: 1124226667
Provider Name (Legal Business Name): ALFONSO RAGUS LLACUNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W ANAHEIM ST
WILMINGTON CA
90744-4417
US

IV. Provider business mailing address

128 W ANAHEIM ST
WILMINGTON CA
90744-4417
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-1245
  • Fax:
Mailing address:
  • Phone: 310-835-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA48198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: