Provider Demographics
NPI:1821246638
Name:CORRADINO, MICHAEL D (DAOC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CORRADINO
Suffix:
Gender:M
Credentials:DAOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4241 JUTLAND DR
Mailing Address - Street 2:103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3663
Mailing Address - Country:US
Mailing Address - Phone:858-490-3460
Mailing Address - Fax:858-490-3462
Practice Address - Street 1:4241 JUTLAND DR
Practice Address - Street 2:202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3663
Practice Address - Country:US
Practice Address - Phone:858-490-3460
Practice Address - Fax:858-490-3462
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist