Individual provider Active NPI

Alma Fragoso-Corona, O.D.

  • Optometrist
  • La Puente, CA
National Provider Identifier
1417000522
Registry record updated Jan 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
11551T Issued in CA
Practice address
15330 Amar Rd Ste a
La Puente, CA 91744-2001
Phone
(626) 961-0432
NPI assigned
Jan 19, 2007
Last updated
Jan 28, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 11551T CA Primary

Addresses

Primary practice location

15330 Amar Rd Ste a
La Puente, CA 91744-2001

Mailing address

1600 Loma Rd
Montebello, CA 90640-3233
Phone (323) 807-0089

Other identifiers 1

IdentifierTypeStateIssuer
SD0011551MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040518000887 CA Practitioner - Optometry 3173514361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1999
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

15330 Amar Rd
La Puente, CA 91744-2001

15330 Amar Rd a
La Puente, CA 91744-2001
Phone (626) 961-0432

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11551TCAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Edward P. & Diane M. Hernandez Optometrist CurrentSince May 14, 1990 Accepting new patients
DRS. Edward P. and Diane M. Hernandez, O.D. Optometrist CurrentSince May 14, 1990 Accepting new patients

Locations

1235 Buena Vista St
Duarte, CA 91010
Phone (626) 359-8145

15330 Amar Rd
Ste A
La Puente, CA 91744
Phone (626) 961-0432

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1417000522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 LOMA RD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403233",
            "telephone_number": "323-807-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15330 AMAR RD STE A",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917442001",
            "telephone_number": "626-961-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAGOSO-CORONA",
        "first_name": "ALMA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11551T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0011551",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Puente, CA

Sources for this page

Verify at the official NPI Registry.