Provider Demographics
NPI:1134941297
Name:CORONADO, CECILIA (AMFT)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N PRAIRIE AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4512
Mailing Address - Country:US
Mailing Address - Phone:310-258-9677
Mailing Address - Fax:
Practice Address - Street 1:301 N PRAIRIE AVE STE 510
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4512
Practice Address - Country:US
Practice Address - Phone:301-258-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist