Felipe De Jesus Coronado, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

55499 Issued in CA

Practice address

1111 Grand Ave Ste K
Diamond Bar, CA 91765-4172

Phone

(909) 860-4254

Fax

(098) 602-6749

NPI assigned

Dec 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Dermatology InstituteGroup PAC ID 2062546260, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles (6 of 7)

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pacific Dermatology Institute

  • Dermatology Physician
  • Corona, CA
  • NPI 1740410182

  CA

  Medicare reassignment Care Compare group
• Dermesurge Inc

  • Dermatology Physician
  • Diamond Bar, CA
  • NPI 1538743752

  CA

  Medicare reassignment
• Longhorn Emergency Medical Associates PA

  • Emergency Medicine Physician
  • Austin, TX
  • NPI 1649669672

  TX

  Medicare reassignment
• Sinus & Allergy Specialists of Texas

  • Allergy & Immunology Physician
  • Austin, TX
  • NPI 1639510803

  TX

  Medicare reassignment
• La Laser Center PC, a Professional Medical Corporation

  • Non-Pharmacy Dispensing Site
  • Turlock, CA
  • NPI 1356974059
  NPD (past)
• Bcep PA

  • Emergency Medical Services (Emergency Medicine) Physician
  • Austin, TX
  • NPI 1629291844
  NPD (past)
• La Laser Center PC, a Professional Medical Corporation

  • Non-Pharmacy Dispensing Site
  • Lake Havasu City, AZ
  • NPI 1245864016
  NPD (past)
• La Laser Center PC, a Professional Medical Corporation

  • Medical Specialty Clinic/Center
  • Gilbert, AZ
  • NPI 1619699360
  NPD (past)
• La Laser Center PC, a Professional Medical Corporation

  • Medical Specialty Clinic/Center
  • Mesa, AZ
  • NPI 1992427199
  NPD (past)
• St. David'S Carenow Urgent Care PLLC

  • Family Medicine Physician
  • Austin, TX
  • NPI 1851844104
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1508920059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 GRAND AVE STE K",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654172",
            "telephone_number": "909-860-4254",
            "fax_number": "098-602-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GRAND AVE STE K",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654172",
            "telephone_number": "909-860-4254",
            "fax_number": "098-602-6749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3724 Executive Center Dr Ste G10",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787311665",
            "country_code": "US",
            "telephone_number": "512-345-5925 x273",
            "fax_number": "512-343-7113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "175 S Harbor Blvd",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928053710",
            "country_code": "US",
            "telephone_number": "909-860-4254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CORONADO",
        "first_name": "FELIPE",
        "middle_name": "DE JESUS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05049",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA2459",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "8258",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA05049",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coast 2 Coast Transportation
• Cogdiversified, a Marriage & Family Counseling Professional Corporation
• Colima Endoscopy Center Inc
• Community Counseling and Coaching Center
• Connie J Li MD a Professional Corporation
• Florencia Quezada Cortes
• Anna Jane Couch, LMFT
• Country Medical Corporation
• Robert Cousins, LHAD
• Jessica Crane, DPT

• All providers in Diamond Bar, CA
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.