Healthcare Provider Details

I. General information

NPI: 1114836814
Provider Name (Legal Business Name): MAITE MARTINEZ CORONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S HIGLEY RD STE 103-477
GILBERT AZ
85296-1166
US

IV. Provider business mailing address

2828 GREENBRIAR DR APT 3101
HOUSTON TX
77098-1494
US

V. Phone/Fax

Practice location:
  • Phone: 769-274-6134
  • Fax:
Mailing address:
  • Phone: 769-274-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: