Bryan Cabconce Coronel, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

794627 Issued in CA

Practice address

1341 Historical Plaza Way
Manteca, CA 95336-5064

Phone

(209) 824-1893

NPI assigned

Feb 21, 2020

Last updated

Jun 4, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Lifetreat Nursing Corporation

  dba Lifetreat urgentcare and wellness center

  • Family Nurse Practitioner
  • Stockton, CA
  • NPI 1912699802
  NPD
• Dignity Health

  dba Mercy Medical Center Redding

  • General Acute Care Hospital
  • Redding, CA
  • NPI 1477671535
  NPD (past)

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1710510326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 E HAMMER LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103149",
            "telephone_number": "209-954-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 HISTORICAL PLAZA WAY",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953365064",
            "telephone_number": "209-824-1893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORONEL",
        "first_name": "BRYAN",
        "middle_name": "CABCONCE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "794627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Medical Centers, Inc. (Community Medical Center)
• Community Medical Centers, Inc.
• Halsey Corbett, P.T.
• Teresa Tjeda Corbett, DPT
• Coronado Bay, LLC (Harvest Crossing Post-Acute)
• Myrna Leah Coronel, PHARM.D.
• Melissa Cortez de la Cruz
• Daniel Cortez
• Monica Marie Cortez
• Costco Wholesale Corporation (Costco Hearing Aid #1031)

• Family Nurse Practitioner in Manteca, CA
• Providers in Manteca, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.