Healthcare Provider Details

I. General information

NPI: 1386888055
Provider Name (Legal Business Name): ALBERTO A CORONEL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 E BEVERLY BLVD
LOS ANGELES CA
90022-2002
US

IV. Provider business mailing address

1000 SAN GABRIEL BLVD STE 200
ROSEMEAD CA
91770-4394
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-0019
  • Fax:
Mailing address:
  • Phone: 323-724-0019
  • Fax: 323-248-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS8976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: