Healthcare Provider Details

I. General information

NPI: 1194355925
Provider Name (Legal Business Name): CORONA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 N 83RD AVE STE 290
PEORIA AZ
85381-5650
US

IV. Provider business mailing address

6107 N 126TH AVE
LITCHFIELD PARK AZ
85340-9541
US

V. Phone/Fax

Practice location:
  • Phone: 623-297-7973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO CORONA TORRES
Title or Position: OWNER
Credential: LPC
Phone: 623-297-7973