Provider Demographics
NPI:1669513768
Name:CORONADO, MARIA LUZ (IMF)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUZ
Last Name:CORONADO
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E. FOOTHILL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376
Mailing Address - Country:US
Mailing Address - Phone:909-421-9435
Mailing Address - Fax:909-421-9436
Practice Address - Street 1:850 E. FOOTHILL BOULEVARD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376
Practice Address - Country:US
Practice Address - Phone:909-421-9435
Practice Address - Fax:909-421-9436
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF42394106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist