Provider Demographics
NPI:1497060529
Name:ELSY M. CORONADO, MD, PA
Entity Type:Organization
Organization Name:ELSY M. CORONADO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-710-9937
Mailing Address - Street 1:9692 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6246
Mailing Address - Country:US
Mailing Address - Phone:305-710-9937
Mailing Address - Fax:305-633-6773
Practice Address - Street 1:9692 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6246
Practice Address - Country:US
Practice Address - Phone:305-710-9937
Practice Address - Fax:305-633-6773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91527305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization