Healthcare Provider Details

I. General information

NPI: 1659971042
Provider Name (Legal Business Name): CORONA HEALTH SPECIALTY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W 6TH ST STE 101
CORONA CA
92882-3349
US

IV. Provider business mailing address

940 N HAVEN AVE STE 18025
ONTARIO CA
91764-4970
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-0910
  • Fax:
Mailing address:
  • Phone: 951-808-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT GUY NELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-808-6240