Healthcare Provider Details

I. General information

NPI: 1730936238
Provider Name (Legal Business Name): CAROLINA CORONADO CRISAFI IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5981 SW 69TH AVE FL 33143
MIAMI FL
33143-1939
US

IV. Provider business mailing address

5981 SW 69TH AVE FL 33143
MIAMI FL
33143-1939
US

V. Phone/Fax

Practice location:
  • Phone: 786-210-7525
  • Fax:
Mailing address:
  • Phone: 786-210-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-312396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: