Provider Demographics
NPI:1982376000
Name:MAGALLANES-CORONADO, ERICK (PA-C)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:MAGALLANES-CORONADO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N LAMAR BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-575-9555
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:1103 RIVERY BLVD # 145
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3034
Practice Address - Country:US
Practice Address - Phone:512-572-4905
Practice Address - Fax:512-782-9316
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA15147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant