Provider Demographics
NPI:1417112970
Name:JOSE MARIA PARTIDA CORONA MD PC
Entity Type:Organization
Organization Name:JOSE MARIA PARTIDA CORONA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:PARTIDA CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-565-6004
Mailing Address - Street 1:2950 E FLAMINGO RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5208
Mailing Address - Country:US
Mailing Address - Phone:702-565-6004
Mailing Address - Fax:702-566-6009
Practice Address - Street 1:2950 E FLAMINGO RD
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5208
Practice Address - Country:US
Practice Address - Phone:702-565-6004
Practice Address - Fax:702-566-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11639207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417112970Medicaid
NVAM501Medicare PIN