Basic Information
| Provider Information | |||||||||
| NPI: | 1417169848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORNATZER | ||||||||
| FirstName: | PAULINA | ||||||||
| MiddleName: | MONIKA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOCHON | ||||||||
| OtherFirstName: | PAULINA | ||||||||
| OtherMiddleName: | MONIKA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 817 PRINCETON AVE SW | ||||||||
| Address2: | POB II, STE 300 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057837970 | ||||||||
| FaxNumber: | 2057837695 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 PRINCETON AVE SW | ||||||||
| Address2: | POB II, STE 300 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057837970 | ||||||||
| FaxNumber: | 2057837695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2007 | ||||||||
| LastUpdateDate: | 12/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 29943 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102I115451 | 01 | AL | MEDICARE | OTHER | 04655362 | 05 | MS | MEDICAID | 051120188 | 01 | AL | BCBS | OTHER | Z30031 | 01 | AL | VIVA | OTHER | 131753 | 05 | AL | MEDICAID | 051120187 | 01 | AL | BCBS | OTHER | 131752 | 05 | AL | MEDICAID | 051120189 | 01 | AL | BCBS | OTHER | 131747 | 05 | AL | MEDICAID |