Healthcare Provider Details

I. General information

NPI: 1437799475
Provider Name (Legal Business Name): VIVIAN PATRICIA CORONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

IV. Provider business mailing address

1865 HOTEL CIR S
SAN DIEGO CA
92108-3319
US

V. Phone/Fax

Practice location:
  • Phone: 619-346-4020
  • Fax:
Mailing address:
  • Phone: 619-673-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: