Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | ME0041646 | FL |
NPI | 1083778641 |
---|---|
Provider Name | Dr. Ignacio Coro |
First Address | Miami, FL 33165-3944 |
Second Address | Miami, FL 33165-3944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267444100 | MEDICAID PROVIDER (01) | FL |
D63750 | (02) | FL |