MEDICARE: ANA KAREN CORONA ISMERIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1184458978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANA KAREN CORONA ISMERIO

Provider Business Mailing Address
First Line	:	641 E SAN YSIDRO BLVD # B3-1436
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-3129
Country	:	US
Telephone Number	:	562-352-0417
Fax Number	:	562-366-0560

Provider Business Practice Location Address
First Line	:	AVE VENECIA N-2 22791
Second Line	:
City	:	TIJUANA
State	:	BC
Zip	:	22205
Country	:	MX
Telephone Number	:	562-352-0417
Fax Number	:	562-366-0560

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANA KAREN CORONA ISMERO
Credential	:	DDS
Telephone Number	:	562-352-0417

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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Directions to “ANA KAREN CORONA ISMERIO ” Practice Location

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