Provider Demographics
NPI:1891954152
Name:DEAQUINO-CORLEY, KAREN GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN GRACE
Middle Name:
Last Name:DEAQUINO-CORLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN GRACE
Other - Middle Name:V
Other - Last Name:DE AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 RESPONSE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4807
Mailing Address - Country:US
Mailing Address - Phone:916-614-4450
Mailing Address - Fax:916-614-4599
Practice Address - Street 1:1650 RESPONSE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:916-614-4450
Practice Address - Fax:916-614-4599
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAC0552605-053390200000X
CAA105785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program