Provider Demographics
NPI:1043453202
Name:CORONA, JUAN GABRIEL (PA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:GABRIEL
Last Name:CORONA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 S UNION AVE STE C2
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-4159
Mailing Address - Country:US
Mailing Address - Phone:661-885-7007
Mailing Address - Fax:661-735-3699
Practice Address - Street 1:2303 S UNION AVE STE C2
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-4159
Practice Address - Country:US
Practice Address - Phone:661-885-7007
Practice Address - Fax:661-735-3699
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20231363A00000X
CA20231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20231OtherPA CA LICENSE
CAPA20231Medicaid
CAPA20231Medicaid