Healthcare Provider Details

I. General information

NPI: 1033646435
Provider Name (Legal Business Name): JINY ELIZABETH CORONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 N RIVERSIDE DR
KELLER TX
76244-2118
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 817-347-2600
  • Fax: 817-347-2670
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-885-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS2967
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: