Individual
BRYAN CABCONCE CORONEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1341 HISTORICAL PLAZA WAY, MANTECA, CA 95336-5064
(209) 824-1893
Mailing address
1530 E HAMMER LN, STOCKTON, CA 95210-3149
(209) 954-3200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
794627
CA
Other
Enumeration date
02/21/2020
Last updated
06/04/2020
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