Provider Demographics
NPI:1801360110
Name:CORONA, ABEL
Entity Type:Individual
Prefix:
First Name:ABEL
Middle Name:
Last Name:CORONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13607 MONTE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95012-2914
Mailing Address - Country:US
Mailing Address - Phone:831-428-2057
Mailing Address - Fax:
Practice Address - Street 1:204 E BEACH ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4809
Practice Address - Country:US
Practice Address - Phone:831-728-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22631124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist