Organization
CORAESTHETICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE JENNETTE CORACIDES PA-C (MEMBER MANAGER)
(480) 307-3497
Entity
Organization
Contact information
Practice address
2008 E LAGUNA DR, TEMPE, AZ 85282
(480) 307-3497
Mailing address
2008 E LAGUNA DR, TEMPE, AZ 85282-5915
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4462
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4462
PHYSICIAN ASSISTANT LICENCE
AZ
Enumeration date
02/23/2018
Last updated
07/09/2018
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