Provider Demographics
NPI:1891899175
Name:CORONA PHYSICIANS ASSOCIATES, A MEDICAL CORP
Entity Type:Organization
Organization Name:CORONA PHYSICIANS ASSOCIATES, A MEDICAL CORP
Other - Org Name:CORONA CLINICA MEDICA FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ-VILLALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-273-1188
Mailing Address - Street 1:217 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1438
Mailing Address - Country:US
Mailing Address - Phone:951-273-1188
Mailing Address - Fax:951-346-3107
Practice Address - Street 1:217 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1438
Practice Address - Country:US
Practice Address - Phone:951-273-1188
Practice Address - Fax:951-284-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMM00199MMedicare PIN