Provider Demographics
NPI:1811462179
Name:CORONEL, MARTIN SOTO
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:SOTO
Last Name:CORONEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ZONAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1026
Mailing Address - Country:US
Mailing Address - Phone:323-409-5050
Mailing Address - Fax:323-226-5126
Practice Address - Street 1:2010 ZONAL AVE RM 4P81
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1026
Practice Address - Country:US
Practice Address - Phone:323-409-5050
Practice Address - Fax:323-226-5126
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker