Healthcare Provider Details

I. General information

NPI: 1295545622
Provider Name (Legal Business Name): SELENIA SARINA CORADO MPA, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SELENIA SARINA CORADO-LOPEZ MPA, PA-C

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22481 ASPAN ST STE A
LAKE FOREST CA
92630-1648
US

IV. Provider business mailing address

31351 RANCHO VIEJO RD STE 201
SAN JUAN CAPISTRANO CA
92675-1858
US

V. Phone/Fax

Practice location:
  • Phone: 949-240-2272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: