Provider Demographics
NPI:1558324608
Name:CORACERO, OSCAR (ATC)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:CORACERO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 UNION ST
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4534
Mailing Address - Country:US
Mailing Address - Phone:909-875-4095
Mailing Address - Fax:
Practice Address - Street 1:13500 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:ETIWANDA
Practice Address - State:CA
Practice Address - Zip Code:91739-2043
Practice Address - Country:US
Practice Address - Phone:909-899-2531
Practice Address - Fax:909-899-3661
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer