Provider Demographics
NPI:1245681238
Name:CORONA LEAL, WENDOLYNE NASHELLY (DDS)
Entity type:Individual
Prefix:MRS
First Name:WENDOLYNE
Middle Name:NASHELLY
Last Name:CORONA LEAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 BONITA RD. #233
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE ISLA TIBURON 3662
Practice Address - Street 2:LAMAS DEL MATAMOROS
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22206
Practice Address - Country:MX
Practice Address - Phone:01552664-665-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6174536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist