Healthcare Provider Details

I. General information

NPI: 1417112970
Provider Name (Legal Business Name): JOSE MARIA PARTIDA CORONA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 702-565-6004
  • Fax: 702-566-6009
Mailing address:
  • Phone: 702-565-6004
  • Fax: 702-566-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11639
License Number StateNV

VIII. Authorized Official

Name: JOSE MARIA PARTIDA CORONA
Title or Position: PRESIDENT
Credential: MD
Phone: 702-565-6004