Provider Demographics
NPI:1700461795
Name:CORONADO CROUCHER, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:CORONADO CROUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18802 NARIMORE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2618
Mailing Address - Country:US
Mailing Address - Phone:813-659-7617
Mailing Address - Fax:
Practice Address - Street 1:18802 NARIMORE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2618
Practice Address - Country:US
Practice Address - Phone:813-659-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist