Provider Demographics
NPI:1942505888
Name:CORONADO, DELLANIRA (ASLP)
Entity Type:Individual
Prefix:
First Name:DELLANIRA
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:ASLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3105
Mailing Address - Country:US
Mailing Address - Phone:956-565-9300
Mailing Address - Fax:956-565-9686
Practice Address - Street 1:327 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3105
Practice Address - Country:US
Practice Address - Phone:956-565-9300
Practice Address - Fax:956-565-9686
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184911901Medicaid