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General NPI Number Information
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NPI Number | 1528672110
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Entity Type | Individual
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Provider Name | CHRISTOPHER TRIA CORONEL NP
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Gender | Male
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 3435 GARDEN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90039-1919
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Country | US
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Telephone | 626-475-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 GARDEN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90039-1919
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Country | US
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Telephone | 626-475-3610
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95015243
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License Number State | CA
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