Healthcare Provider Details

I. General information

NPI: 1730825431
Provider Name (Legal Business Name): CLAIRE ELISE GRAYSON CORONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAIRE ELISE GRAYSON MD

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0945
  • Fax:
Mailing address:
  • Phone: 602-933-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number76248
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: