MEDICARE: JAMNY CORONADO M.S.

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	207Q00000X	Family Medicine Physician	5319	FL
2	101YM0800X	Mental Health Counselor	IMH5319	FL

General Provider Information

NPI Number	:	1659592053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMNY CORONADO M.S.

Provider Business Mailing Address
First Line	:	16182 SW 61ST LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5798
Country	:	US
Telephone Number	:	786-974-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5040 NW 7TH ST STE 530
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3432
Country	:	US
Telephone Number	:	305-995-0141
Fax Number	:	305-995-0144

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	02/29/2024

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