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General NPI Number Information
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NPI Number | 1780141317
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Entity Type | Individual
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Provider Name | ITZEL CORONADO LAC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 21040 HOMESTEAD RD STE 102
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City | CUPERTINO
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State | CA
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Zip | 95014-0238
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Country | US
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Telephone | 408-413-8315
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Fax | 408-743-5445
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Provider Business Mailing Address
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Address Line | 1534 LOCHNER DR
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City | SAN JOSE
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State | CA
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Zip | 95127-4765
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Country | US
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Telephone | 408-413-8315
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 18400
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License Number State | CA
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