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General NPI Number Information
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NPI Number | 1104433176
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Entity Type | Organization
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Legal Business Name | CORONA HEALTH SPECIALTY ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 2250 S MAIN ST STE 201
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City | CORONA
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State | CA
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Zip | 92882-2536
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Country | US
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Telephone | 951-734-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 TOWN AND COUNTRY DR STE 104
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City | NORCO
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State | CA
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Zip | 92860-3611
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Country | US
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Telephone | 951-808-6240
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Fax | 951-738-9954
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT G NELSON
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Credential | MD
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Telephone | 951-808-6240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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