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NPI Code Detail

MEDICARE: DR. FABIAN CORONA O.D.

MEDICARE:  DR. FABIAN  CORONA  O.D.
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
1152W00000XOptometrist14923CA

General Provider Information

NPI Number : 1821401886
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FABIAN CORONA O.D.
Provider Business Mailing Address
First Line : 3329 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-4324
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3329 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-4324
Country : US
Telephone Number : 323-566-6183
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2014
Last Update Date : 11/24/2014

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Directions to “ DR. FABIAN CORONA O.D.” Practice Location

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