=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770401440
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESUS CORONA PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2026
-----------------------------------------------------
Last Update Date | 07/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 A ST
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94509-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-757-8787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 632 RICE ST
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94513-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-375-7243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 54798
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------