Provider Demographics
NPI:1528039500
Name:AGRAWAL, PRAMILA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMILA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 W BONITA AVE
Mailing Address - Street 2:#200
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1850
Mailing Address - Country:US
Mailing Address - Phone:909-629-5067
Mailing Address - Fax:909-865-7688
Practice Address - Street 1:250 W BONITA AVE
Practice Address - Street 2:#200
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1850
Practice Address - Country:US
Practice Address - Phone:909-629-5067
Practice Address - Fax:909-865-7688
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42046208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA137704OtherAAP #
CABA0230475OtherDEA #
CABA0230475OtherDEA #