1740803915 NPI number — GUADALUPE HORTENCIA CORONADO MD

Table of content: GUADALUPE HORTENCIA CORONADO MD (NPI 1740803915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740803915 NPI number — GUADALUPE HORTENCIA CORONADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORONADO
Provider First Name:
GUADALUPE
Provider Middle Name:
HORTENCIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740803915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HILLMONT AVE.
Provider Second Line Business Mailing Address:
BLDG 340, 101&201
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-652-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HILLMONT AVE.
Provider Second Line Business Practice Location Address:
BLDG 340, 101&201
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-652-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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