Provider Demographics
NPI:1598701310
Name:CORONADO, JOSE (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:CORONADO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:STE 300
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-254-1774
Mailing Address - Fax:707-251-2988
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:STE 100
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6484
Practice Address - Country:US
Practice Address - Phone:707-254-1770
Practice Address - Fax:707-254-1779
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2019-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA54534363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP10959OtherTERM NP