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General NPI Number Information
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NPI Number | 1508920059
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Entity Type | Individual
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Provider Name | FELIPE DE JESUS CORONADO PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 1111 GRAND AVE STE K
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4172
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Country | US
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Telephone | 909-860-4254
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Fax | 98-602-6749
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Provider Business Mailing Address
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Address Line | 1111 GRAND AVE STE K
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4172
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Country | US
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Telephone | 909-860-4254
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Fax | 98-602-6749
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA05049
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2459
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 8258
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55499
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License Number State | CA
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