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NPI Code Detail

MEDICARE: HERCILIA CORONA PH.D.

MEDICARE:   HERCILIA  CORONA  PH.D.
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
1103TC0700XClinical Psychologist9964MA
2103TC0700XClinical Psychologist28127CA

General Provider Information

NPI Number : 1447541578
Entity Type Code : Individual
Provider Name (Legal Business Name) : HERCILIA CORONA PH.D.
Provider Business Mailing Address
First Line : 2774 JEFFERSON ST
Second Line :
City : CARLSBAD
State : CA
Zip : 92008-1769
Country : US
Telephone Number : 858-707-5321
Fax Number :
Provider Business Practice Location Address
First Line : 2774 JEFFERSON ST
Second Line :
City : CARLSBAD
State : CA
Zip : 92008-1769
Country : US
Telephone Number : 858-707-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2011
Last Update Date : 07/21/2022

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