Provider Demographics
NPI:1124298591
Name:CORONA, KARLA A (LMP)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:A
Last Name:CORONA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 S 11TH ST STE 15
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4091
Mailing Address - Country:US
Mailing Address - Phone:253-272-1825
Mailing Address - Fax:
Practice Address - Street 1:1206 S 11TH ST STE 15
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4091
Practice Address - Country:US
Practice Address - Phone:253-272-1825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-02
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA8769305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization