Provider Demographics
NPI:1912098302
Name:CORONADO, ANAIDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANAIDA
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANAIDA
Other - Middle Name:CORONADO
Other - Last Name:GRATACOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:CALLE HOLLYWOOD DRIVE # 7
Mailing Address - Street 2:URB. HOLLYWOOD ESTATES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-789-4015
Mailing Address - Fax:787-789-4015
Practice Address - Street 1:CALLE HOLLYWOOD DR. 7
Practice Address - Street 2:URB. HOLLYWOOD ESTATES
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-789-4015
Practice Address - Fax:787-789-4015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice