Healthcare Provider Details

I. General information

NPI: 1306474994
Provider Name (Legal Business Name): EDGAR CORONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 BALDWIN PARK BLVD
BALDWIN PARK CA
91706-2656
US

IV. Provider business mailing address

505 PARNASSUS AVE # 119
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 626-862-3307
  • Fax:
Mailing address:
  • Phone: 626-862-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA186864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: