Provider Demographics
NPI:1124226667
Name:LLACUNA, ALFONSO RAGUS (MD)
Entity type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:RAGUS
Last Name:LLACUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-4417
Mailing Address - Country:US
Mailing Address - Phone:310-835-1245
Mailing Address - Fax:
Practice Address - Street 1:128 W ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-4417
Practice Address - Country:US
Practice Address - Phone:310-835-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48198208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481982Medicaid
CA00A481982Medicaid