Provider Demographics
NPI:1982286357
Name:CORONA, NEREIDA (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 E BARDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-5400
Mailing Address - Country:US
Mailing Address - Phone:559-302-0073
Mailing Address - Fax:
Practice Address - Street 1:559 E BARDSLEY AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-5400
Practice Address - Country:US
Practice Address - Phone:559-688-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA713024164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty