Provider Demographics
NPI:1225145816
Name:CORONA MEDICAL CENTER, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CORONA MEDICAL CENTER, A PROFESSIONAL CORPORATION
Other - Org Name:CORONA FAMILY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASNAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-737-1000
Mailing Address - Street 1:PO BOX 3070
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3070
Mailing Address - Country:US
Mailing Address - Phone:951-737-1000
Mailing Address - Fax:951-737-1558
Practice Address - Street 1:1157 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4364
Practice Address - Country:US
Practice Address - Phone:951-737-1000
Practice Address - Fax:951-737-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A732183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA625788470Medicaid
CA625788470Medicaid
CAZZZ15583ZMedicare ID - Type UnspecifiedMEDICARE #