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General NPI Number Information
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NPI Number | 1740891720
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Entity Type | Individual
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Provider Name | MADELEINE CORONADO
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3734 6TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-4317
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Country | US
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Telephone | 619-354-7400
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Fax | 619-574-6964
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Provider Business Mailing Address
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Address Line | 3734 6TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-4317
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Country | US
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Telephone | 619-354-7400
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Fax | 619-574-6964
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36198
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License Number State | CA
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