Provider Demographics
NPI:1417100322
Name:CORONEL, MARLEEN SANTOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLEEN
Middle Name:SANTOS
Last Name:CORONEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3372
Mailing Address - Country:US
Mailing Address - Phone:559-439-5757
Mailing Address - Fax:559-248-9585
Practice Address - Street 1:1275 E SPRUCE AVE
Practice Address - Street 2:STE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3372
Practice Address - Country:US
Practice Address - Phone:559-439-5757
Practice Address - Fax:559-248-9585
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine