Individual
CARLOS G CORONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 772-1777
Mailing address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 772-1777
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-22-1385
OR
247200000X
Other Technician
—
—
Other
Enumeration date
07/21/2021
Last updated
02/28/2022
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