MEDICARE: JESUS CORONADO JR. LPN

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	164W00000X	Licensed Practical Nurse	LP034712	AZ

General Provider Information

NPI Number	:	1750697785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS CORONADO JR. LPN

Provider Business Mailing Address
First Line	:	6821 W TUMBLING T
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85757-9507
Country	:	US
Telephone Number	:	520-461-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 W TUMBLING T
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85757-9507
Country	:	US
Telephone Number	:	520-461-5051
Fax Number	:

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

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	08/27/2010

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