MEDICARE: MINERVA G CORONADO MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1164700365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINERVA G CORONADO MSW

Provider Business Mailing Address
First Line	:	95 E PRICE RD STE B2
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-3578
Country	:	US
Telephone Number	:	956-550-0499
Fax Number	:	956-550-0550

Provider Business Practice Location Address
First Line	:	95 E PRICE RD STE B2
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-3578
Country	:	US
Telephone Number	:	956-550-0499
Fax Number	:	956-550-0550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	03/22/2025

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