Individual provider Active NPI

Myrna Coronado, MD

  • Adult Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1710147566
Registry record updated Feb 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
A112627 Issued in CA
Practice address
865 3Rd Ave
Suite 133
Chula Vista, CA 91911-1300
Phone
(619) 428-1330
Fax
(619) 427-0134
NPI assigned
Jun 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X A112627 CA Primary

Addresses

Primary practice location

865 3Rd Ave
Suite 133
Chula Vista, CA 91911-1300

Mailing address

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-1330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110328000563 CA Practitioner - Family Practice 5991988099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albany Medical College of Union University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, 291 clinicians

Practice addresses (Care Compare)

1637 3Rd Ave
Suite B
Chula Vista, CA 91911-5823
Phone (619) 662-4100

316 25TH St
San Diego, CA 92102-3016
Phone (619) 662-4100

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-4463

4050 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 662-4100

678 3Rd Ave
Chula Vista, CA 91910-5736
Phone (619) 662-4100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
112627CAMDMarriage & Family Therapist
A112627CAMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Feb 2, 2011 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Feb 2, 2011 Accepting new patients
Grossmont Hospital Corporation Past Accepting new patients
Scripps Health Past Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Regents of the University of California Past Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Sharp Coronado Hospital and Healthcare Center Past Accepting new patients

Locations

865 Third Ave
Ste 133
Chula Vista, CA 91911
Phone (619) 205-1360

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mcoronado18521@syhealth.direct-ci.com

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296604800000",
    "number": "1710147566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-428-1330",
            "fax_number": "619-428-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 3RD AVE",
            "address_2": "SUITE 133",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919111300",
            "telephone_number": "619-428-1330",
            "fax_number": "619-427-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORONADO",
        "first_name": "MYRNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-16",
        "last_updated": "2011-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "A112627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.