Provider Demographics
NPI:1073058293
Name:CORONADO, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:CORONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2059
Mailing Address - Country:US
Mailing Address - Phone:509-892-9241
Mailing Address - Fax:509-892-9251
Practice Address - Street 1:1700 S ASSEMBLY RD STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-2116
Practice Address - Country:US
Practice Address - Phone:509-892-9241
Practice Address - Fax:509-892-9251
Is Sole Proprietor?:No
Enumeration Date:2016-12-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist