Provider Demographics
NPI:1417300591
Name:CORONADO, CAROLINA (LPT)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:CORONADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:14505 RAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14505 RAYFIELD DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4128
Practice Address - Country:US
Practice Address - Phone:562-587-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28790167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician