Healthcare Provider Details

I. General information

NPI: 1396321873
Provider Name (Legal Business Name): DAVID ENRIQUE CORDERO CORONADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WEST BROADWAY
VANCOUVER BRITISH COLUMBIA
V6J 1Y2
CA

IV. Provider business mailing address

1711 WEST BROADWAY
VANCOUVER BRITISH COLUMBIA
V6J 1Y2
CA

V. Phone/Fax

Practice location:
  • Phone: 647-997-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT61108921
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: