Healthcare Provider Details

I. General information

NPI: 1881806347
Provider Name (Legal Business Name): MRS. CORAZON B. VIOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N STATE COLLEGE BLVD
FULLERTON CA
92831-3547
US

IV. Provider business mailing address

15222 NORMANDY LN
LA MIRADA CA
90638-4700
US

V. Phone/Fax

Practice location:
  • Phone: 714-278-2872
  • Fax: 714-278-3069
Mailing address:
  • Phone: 714-278-2872
  • Fax: 714-278-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberMTA32793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: