Provider Demographics
NPI:1962808865
Name:CORONA, CEASAR
Entity type:Individual
Prefix:
First Name:CEASAR
Middle Name:
Last Name:CORONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6819 HINDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-6009
Mailing Address - Country:US
Mailing Address - Phone:818-342-5897
Mailing Address - Fax:818-975-5008
Practice Address - Street 1:7101 BAIRD AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4150
Practice Address - Country:US
Practice Address - Phone:818-342-5897
Practice Address - Fax:818-975-5008
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CAB00002281221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker