Provider Demographics
NPI:1598436032
Name:CORONADO, LISBETH
Entity Type:Individual
Prefix:
First Name:LISBETH
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISBETH
Other - Middle Name:
Other - Last Name:ARMENTA RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:43101 PORTOLA AVE SPC 63
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2502
Mailing Address - Country:US
Mailing Address - Phone:760-902-1011
Mailing Address - Fax:
Practice Address - Street 1:43101 PORTOLA AVE SPC 63
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2502
Practice Address - Country:US
Practice Address - Phone:760-902-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty