MEDICARE: VIOLETA CORONADO LMT, MLDT

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	225700000X	Massage Therapist	MT-13020	AZ

General Provider Information

NPI Number	:	1366172686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIOLETA CORONADO LMT, MLDT

Provider Business Mailing Address
First Line	:	1601 N TUCSON BLVD STE 14A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3406
Country	:	US
Telephone Number	:	520-719-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N TUCSON BLVD STE 14A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3406
Country	:	US
Telephone Number	:	520-719-0090
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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