Healthcare Provider Details

I. General information

NPI: 1831476340
Provider Name (Legal Business Name): ISRAEL CORONADO C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N STOCKTON HILL RD
KINGMAN AZ
86409-0514
US

IV. Provider business mailing address

1016 S MILE 2 1/2 W
WESLACO TX
78596-0501
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-3636
  • Fax: 928-757-3635
Mailing address:
  • Phone: 956-246-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number737234
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number324558
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: