Provider Demographics
NPI:1013109461
Name:CORADO, KATYA C (MD)
Entity type:Individual
Prefix:
First Name:KATYA
Middle Name:C
Last Name:CORADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2944
Mailing Address - Country:US
Mailing Address - Phone:562-599-8601
Mailing Address - Fax:562-218-0853
Practice Address - Street 1:1333 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2944
Practice Address - Country:US
Practice Address - Phone:562-599-8601
Practice Address - Fax:562-218-0853
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA6447OtherRRM
CAM050376OtherGROUP
CAM050376OtherGROUP
CAAZ676YMedicare PIN