Basic Information
| Provider Information | |||||||||
| NPI: | 1891313250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRAGOSO | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | JULIEN | ||||||||
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| Credential: | M.S., AMFT, APCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 72 | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906600072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236973323 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11500 PARAMOUNT BLVD | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629234545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2020 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 119543 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.