Healthcare Provider Details

I. General information

NPI: 1801360110
Provider Name (Legal Business Name): ABEL CORONA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2019
Last Update Date: 01/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

13607 MONTE DEL SOL
CASTROVILLE CA
95012-2914
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax:
Mailing address:
  • Phone: 831-428-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: