Provider Demographics
NPI:1982167896
Name:CORONADO, PRISCILLA (PA-C)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:CORONADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 E 24TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3289
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2660 E 24TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365
Practice Address - Country:US
Practice Address - Phone:928-483-5658
Practice Address - Fax:928-483-5314
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7638OtherSTATE LICENSE NUMBER