Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 46255 | CA |
Y | 213EG0000X | General Practice | 46255 | CA |
NPI | 1003831769 |
---|---|
Provider Name | Dr. Marileth Coria |
First Address | Grand Terrace, CA 92313-5203 |
Second Address | Grand Terrace, CA 92313-5203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |