Healthcare Provider Details

I. General information

NPI: 1952670341
Provider Name (Legal Business Name): ANNETTE A CORONEL-PEREY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W REDONDO BEACH BLVD SUITE 100
GARDENA CA
90247-4128
US

IV. Provider business mailing address

1045 W REDONDO BEACH BLVD SUITE 100
GARDENA CA
90247-4128
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-5558
  • Fax:
Mailing address:
  • Phone: 310-532-5558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANNETTE A. CORONEL-PEREY
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 310-532-5558