Provider Demographics
NPI:1336951086
Name:CORALLO TROVAO, KAREN (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:CORALLO TROVAO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:CORALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:372 GLENBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7053
Mailing Address - Country:US
Mailing Address - Phone:209-814-7795
Mailing Address - Fax:
Practice Address - Street 1:561 WICKLUND CROSSING WAY
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95391-1100
Practice Address - Country:US
Practice Address - Phone:209-839-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP1067124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist