Healthcare Provider Details

I. General information

NPI: 1689139065
Provider Name (Legal Business Name): KELSEY BRITTANY CORIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2019
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 C AVE STE 100
CORONADO CA
92118-1992
US

IV. Provider business mailing address

120 C AVE STE 100
CORONADO CA
92118-1992
US

V. Phone/Fax

Practice location:
  • Phone: 209-518-9612
  • Fax:
Mailing address:
  • Phone: 209-518-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number105480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: