Provider Demographics
NPI:1215540075
Name:CORALLO, BRIANNA PAIGE (ATC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:PAIGE
Last Name:CORALLO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 CARLING DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5527
Mailing Address - Country:US
Mailing Address - Phone:310-567-1896
Mailing Address - Fax:
Practice Address - Street 1:4453 CARLING DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5527
Practice Address - Country:US
Practice Address - Phone:310-567-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer