MEDICARE: SIERRA CORONADO

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	1041C0700X	Clinical Social Worker	116895	TX

General Provider Information

NPI Number	:	1922869544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA CORONADO

Provider Business Mailing Address
First Line	:	PO BOX 470
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-0470
Country	:	US
Telephone Number	:	210-201-3663
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 470
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-0470
Country	:	US
Telephone Number	:	210-201-3663
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	02/04/2026

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Directions to “ SIERRA CORONADO ” Practice Location

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