Provider Demographics
NPI:1932850583
Name:CORONADO, JONATHAN E
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:E
Last Name:CORONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48326 HIGHWAY E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-2112
Mailing Address - Country:US
Mailing Address - Phone:660-216-7990
Mailing Address - Fax:
Practice Address - Street 1:48326 HIGHWAY E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-2112
Practice Address - Country:US
Practice Address - Phone:660-216-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program