Provider Demographics
NPI:1356616064
Name:CORONA SURGICAL LLC
Entity type:Organization
Organization Name:CORONA SURGICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SZCZESNIAK
Authorized Official - Suffix:III
Authorized Official - Credentials:RN
Authorized Official - Phone:951-736-0137
Mailing Address - Street 1:2370 ANSELMO DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-736-0137
Mailing Address - Fax:951-734-3597
Practice Address - Street 1:2370 ANSELMO DRIVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-736-0137
Practice Address - Fax:951-734-3597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical