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General NPI Number Information
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NPI Number | 1881185502
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Entity Type | Individual
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Provider Name | IRMA FRAGOSO
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Gender | Female
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 13200 CROSSROADS PKWY N BLDG SUITE # 300
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91746
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Country | US
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Telephone | 562-821-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 255 S GLENDORA AVE
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City | GLENDORA
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State | CA
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Zip | 91740-7222
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Country | US
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Telephone | 626-485-6598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 127103
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License Number State | CA
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