Provider Demographics
NPI:1174628325
Name:BARRAGAN, ALFONSO L (MD FACS)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:L
Last Name:BARRAGAN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S ATLANTIC BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4729
Mailing Address - Country:US
Mailing Address - Phone:626-281-8835
Mailing Address - Fax:626-281-1526
Practice Address - Street 1:850 S ATLANTIC BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4729
Practice Address - Country:US
Practice Address - Phone:626-281-8835
Practice Address - Fax:626-281-1526
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29368208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293681Medicaid
CA00A293681Medicaid
A25734Medicare UPIN