Healthcare Provider Details

I. General information

NPI: 1134646466
Provider Name (Legal Business Name): JOSE MARIA PARTIDA CORONA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E FLAMINGO RD STE E
LAS VEGAS NV
89121-5208
US

IV. Provider business mailing address

2950 E FLAMINGO RD STE E
LAS VEGAS NV
89121-5208
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-6004
  • Fax:
Mailing address:
  • Phone: 702-565-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSE CORONA
Title or Position: MD
Credential:
Phone: 702-256-3637