Provider Demographics
NPI:1508668054
Name:CORONADO, MICHAEL CHRISTIAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:CORONADO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 NW 8TH ST APT 612
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3952
Mailing Address - Country:US
Mailing Address - Phone:516-784-6428
Mailing Address - Fax:
Practice Address - Street 1:3500 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4106
Practice Address - Country:US
Practice Address - Phone:516-784-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program