Provider Demographics
NPI:1013196054
Name:CORUNA, LILY MALABON
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:MALABON
Last Name:CORUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 N RAPHAEL LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6191
Mailing Address - Country:US
Mailing Address - Phone:443-535-5104
Mailing Address - Fax:
Practice Address - Street 1:367 N RAPHAEL LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6191
Practice Address - Country:US
Practice Address - Phone:443-535-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9605225100000X
CA35498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist