Provider Demographics
NPI:1720409188
Name:CORADO, IRVIN
Entity Type:Individual
Prefix:
First Name:IRVIN
Middle Name:
Last Name:CORADO
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 1:1407 DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6411
Mailing Address - Country:US
Mailing Address - Phone:321-452-0800
Mailing Address - Fax:321-394-0385
Practice Address - Street 1:1407 DIXON BLVD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6411
Practice Address - Country:US
Practice Address - Phone:321-452-0800
Practice Address - Fax:321-394-0385
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker