Provider Demographics
NPI:1194876219
Name:CORONA, PAUL DANIEL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DANIEL
Last Name:CORONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30251 GOLDEN LANTERN
Mailing Address - Street 2:SUITE E523
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5993
Mailing Address - Country:US
Mailing Address - Phone:949-481-0118
Mailing Address - Fax:949-349-1940
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:SUITE 216
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-481-0118
Practice Address - Fax:949-349-1940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF26714Medicare UPIN