Provider Demographics
NPI:1922330083
Name:DAMMERT CORONADO, PEDRO MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:MANUEL
Last Name:DAMMERT CORONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 H ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4307
Mailing Address - Country:US
Mailing Address - Phone:619-862-6673
Mailing Address - Fax:619-686-7335
Practice Address - Street 1:435 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4307
Practice Address - Country:US
Practice Address - Phone:619-862-6673
Practice Address - Fax:619-686-7335
Is Sole Proprietor?:No
Enumeration Date:2010-01-31
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0010330207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5321361 00Medicaid
DE1922330083Medicaid
DEP01257424OtherRAIL ROAD MEDICARE
DE1922330083Medicaid