Healthcare Provider Details

I. General information

NPI: 1710287792
Provider Name (Legal Business Name): TRI-CITY INTEGRATED PHYSICIANS SERVICES, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 WARING CT SUITE D
OCEANSIDE CA
92056-4510
US

IV. Provider business mailing address

3231 WARING CT SUITE D
OCEANSIDE CA
92056-4510
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-7402
  • Fax: 760-758-1980
Mailing address:
  • Phone: 760-758-7402
  • Fax: 760-758-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: FRANK EDWARD CORONA
Title or Position: PRESIDENT
Credential: MD
Phone: 760-758-7402