Healthcare Provider Details

I. General information

NPI: 1932492352
Provider Name (Legal Business Name): MR. ALFONSO CORO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

540 N ROSSMORE AVE # 100
LOS ANGELES CA
90004-2444
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-3198
  • Fax:
Mailing address:
  • Phone: 818-970-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: