Provider Demographics
NPI:1164572632
Name:SWEENEY, NATHALY MARIA COROMOTO (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHALY
Middle Name:MARIA COROMOTO
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9300 CAMPUS POINT DR # MC7774
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1300
Mailing Address - Country:US
Mailing Address - Phone:619-543-3759
Mailing Address - Fax:619-543-3812
Practice Address - Street 1:9300 CAMPUS POINT DR # MC7774
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:619-543-3759
Practice Address - Fax:619-543-3812
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDP20264208000000X
CAA1107612080P0202X, 2080N0001X
MDD675152080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018764000Medicaid