Provider Demographics
NPI:1316228729
Name:ALFONSO, KAREN KAY GRAGASIN (MD)
Entity type:Individual
Prefix:
First Name:KAREN KAY
Middle Name:GRAGASIN
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15855 POMONA RINCON RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5572
Mailing Address - Country:US
Mailing Address - Phone:909-929-2511
Mailing Address - Fax:
Practice Address - Street 1:15855 POMONA RINCON RD
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5572
Practice Address - Country:US
Practice Address - Phone:909-929-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHH879ZMedicare PIN