MEDICARE: JOSE MARIA PARTIDA CORONA MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1134646466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE MARIA PARTIDA CORONA MD PC

Provider Business Mailing Address
First Line	:	2950 E FLAMINGO RD STE E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5208
Country	:	US
Telephone Number	:	702-565-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 E FLAMINGO RD STE E
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5208
Country	:	US
Telephone Number	:	702-565-6004
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	JOSE CORONA
Credential	:
Telephone Number	:	702-256-3637

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	08/28/2017

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