Individual
FELIPE DE JESUS CORONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1111 GRAND AVE STE K, DIAMOND BAR, CA 91765-4172
(909) 860-4254
(098) 602-6749
Mailing address
1111 GRAND AVE STE K, DIAMOND BAR, CA 91765-4172
(909) 860-4254
(098) 602-6749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
55499
CA
363A00000X
Physician Assistant
PA05049
TX
363AM0700X
Medical Physician Assistant
8258
AZ
363AM0700X
Medical Physician Assistant
PA2459
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA05049
STATE LICENSE
TX
Enumeration date
12/20/2006
Last updated
11/24/2023
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