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General NPI Number Information
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NPI Number | 1487776605
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Entity Type | Organization
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Legal Business Name | BORIS E CORONADO MD PA
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 5579 S ORANGE AVE
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City | EDGEWOOD
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State | FL
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Zip | 32809-3493
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Country | US
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Telephone | 407-290-0935
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Fax | 407-290-0935
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Provider Business Mailing Address
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Address Line | 1657 CHERRY RIDGE DR
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City | HEATHROW
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State | FL
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Zip | 32746-1943
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Country | US
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Telephone | 407-290-0935
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Fax | 407-290-0935
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BORIS EFRAIN CORONADO
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Credential | MD
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Telephone | 407-290-0935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 72110
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License Number State | FL
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