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NPI Code Detail

MEDICARE: EDGAR CORONADO

MEDICARE: EDGAR CORONADO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1902761505
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDGAR CORONADO
Provider Business Mailing Address
First Line : 500 MARQUETTE AVE NW STE 1200
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-5312
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 MARQUETTE AVE NW STE 1200
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-5312
Country : US
Telephone Number : 505-522-7750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2025
Last Update Date : 12/17/2025

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Directions to “ EDGAR CORONADO ” Practice Location

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