Provider Demographics
NPI:1952670341
Name:ANNETTE A. CORONEL-PEREY,M.D., INC.
Entity Type:Organization
Organization Name:ANNETTE A. CORONEL-PEREY,M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORONEL-PEREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-532-5558
Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:310-532-5558
Mailing Address - Fax:
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-532-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A552530Medicaid