Provider Demographics
NPI:1679365373
Name:CORONADO, KETURAH PATRICE (CSFA)
Entity type:Individual
Prefix:
First Name:KETURAH
Middle Name:PATRICE
Last Name:CORONADO
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36137 WHITE FIR WAY
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-9005
Mailing Address - Country:US
Mailing Address - Phone:678-656-7474
Mailing Address - Fax:
Practice Address - Street 1:36137 WHITE FIR WAY
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-9005
Practice Address - Country:US
Practice Address - Phone:678-656-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL170050246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant