Healthcare Provider Details

I. General information

NPI: 1427825546
Provider Name (Legal Business Name): CASSANDRA CORONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 COTTLE RD
SAN JOSE CA
95123-3640
US

IV. Provider business mailing address

2922 OLIVE ST
HUNTINGTON PARK CA
90255-6410
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-6400
  • Fax:
Mailing address:
  • Phone: 347-656-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: