Provider Demographics
NPI:1902096373
Name:CORONA, CECILIA (N/A)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W CHESTNUT AVE
Mailing Address - Street 2:CAC LOMPOC REGIONAL OFFICE
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5913
Mailing Address - Country:US
Mailing Address - Phone:805-740-4555
Mailing Address - Fax:805-740-4558
Practice Address - Street 1:120 W CHESTNUT AVE
Practice Address - Street 2:CAC LOMPOC REGIONAL OFFICE
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5913
Practice Address - Country:US
Practice Address - Phone:805-740-4555
Practice Address - Fax:805-740-4558
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator