Individual
RONALDO SAN JUAN CORACHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7608 69TH PL APT 2B, GLENDALE, NY 11385-7138
(347) 886-6661
Mailing address
7608 69TH PL APT 2B, GLENDALE, NY 11385-7138
(347) 886-6661
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
018679-1
NY
2251P0200X
Pediatric Physical Therapist
018679-1
NY
Other
Enumeration date
06/22/2010
Last updated
06/22/2010
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