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General NPI Number Information
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NPI Number | 1215891080
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Entity Type | Individual
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Provider Name | JOSE PORFIRIO CORONA-MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 213-258-7455
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 BRISTOL PKWY STE 100
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City | CULVER CITY
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State | CA
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Zip | 90230-6601
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Country | US
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Telephone | 213-258-7455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | CA
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