Provider Demographics
NPI:1215654272
Name:CORNEJO, KARINA (FNP)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:CORNEJO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52192
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-2192
Mailing Address - Country:US
Mailing Address - Phone:949-998-0399
Mailing Address - Fax:
Practice Address - Street 1:2711 E COAST HWY STE 12
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2104
Practice Address - Country:US
Practice Address - Phone:949-998-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95172250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily