Healthcare Provider Details

I. General information

NPI: 1568378156
Provider Name (Legal Business Name): CRISTOPHER CORONADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HILLARY ST APT 40
CALEXICO CA
92231-4360
US

IV. Provider business mailing address

1401 HILLARY ST APT 40
CALEXICO CA
92231-4360
US

V. Phone/Fax

Practice location:
  • Phone: 619-987-3588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberASSISTANT
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: