Healthcare Provider Details

I. General information

NPI: 1780401703
Provider Name (Legal Business Name): JACQUELINE FRANCO CORONA RRT, ALM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2024
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 E INTREPID AVE
MESA AZ
85204-6817
US

IV. Provider business mailing address

1826 E INTREPID AVE
MESA AZ
85204-6817
US

V. Phone/Fax

Practice location:
  • Phone: 480-495-5458
  • Fax:
Mailing address:
  • Phone: 480-495-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: