Healthcare Provider Details

I. General information

NPI: 1619703352
Provider Name (Legal Business Name): KRISTINE CORONADO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

272 MYSTIC SHORES BLVD
SPRING BRANCH TX
78070-5033
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 210-627-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number698664
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: