Provider Demographics
NPI:1558464818
Name:CORONEL PEREY, ANNETTE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:A
Last Name:CORONEL PEREY
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:310-532-5558
Mailing Address - Fax:310-532-5445
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:STE 100
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-532-5558
Practice Address - Fax:310-532-5445
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA55253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A552530Medicaid