Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 016099 | NY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | PA52398 | CA |
NPI | 1003160888 |
---|---|
Provider Name | Andrea Virginia Corpora |
First Address | Rancho Mirage, CA 92270-3221 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2012 |
Last Update Date | 24/02/2016 |