Provider Demographics
NPI:1558622092
Name:CORAZON C. INOCENCIO APDC
Entity Type:Organization
Organization Name:CORAZON C. INOCENCIO APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:C
Authorized Official - Last Name:INOCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-946-8898
Mailing Address - Street 1:991 MONTAGUE EXPWY.
Mailing Address - Street 2:SUITE #205
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6819
Mailing Address - Country:US
Mailing Address - Phone:408-946-8898
Mailing Address - Fax:408-946-1814
Practice Address - Street 1:991 MONTAGUE EXPRESSWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6819
Practice Address - Country:US
Practice Address - Phone:408-946-8898
Practice Address - Fax:408-946-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89822-01OtherBPN