Provider Demographics
NPI:1750697785
Name:CORONADO, JESUS JR (LPN)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:CORONADO
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 W TUMBLING T
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-9507
Mailing Address - Country:US
Mailing Address - Phone:520-461-5051
Mailing Address - Fax:
Practice Address - Street 1:6821 W TUMBLING T
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-9507
Practice Address - Country:US
Practice Address - Phone:520-461-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP034712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse