Healthcare Provider Details

I. General information

NPI: 1457357378
Provider Name (Legal Business Name): ROBERTO B CORALES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 MONROE AVE
ROCHESTER NY
14607-3632
US

IV. Provider business mailing address

259 MONROE AVE
ROCHESTER NY
14607-3632
US

V. Phone/Fax

Practice location:
  • Phone: 585-545-7200
  • Fax: 585-244-6456
Mailing address:
  • Phone: 585-545-7200
  • Fax: 585-244-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number198349
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: