Provider Demographics
NPI:1275819492
Name:CORONEL, DOMENICA
Entity Type:Individual
Prefix:
First Name:DOMENICA
Middle Name:
Last Name:CORONEL
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 1:1225 BENNETT AVE
Mailing Address - Street 2:APT. 308
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5925
Mailing Address - Country:US
Mailing Address - Phone:310-938-4460
Mailing Address - Fax:
Practice Address - Street 1:1225 BENNETT AVE
Practice Address - Street 2:APT. 308
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-5925
Practice Address - Country:US
Practice Address - Phone:310-938-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260778164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse