Healthcare Provider Details

I. General information

NPI: 1255026167
Provider Name (Legal Business Name): MARENA LIA CORONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10726 LIBBY RD
CLERMONT FL
34715
US

IV. Provider business mailing address

130 PALM AVE
CENTER HILL FL
33514-4454
US

V. Phone/Fax

Practice location:
  • Phone: 352-432-1422
  • Fax:
Mailing address:
  • Phone: 210-670-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: