Provider Demographics
NPI:1679351340
Name:CORONADO, IVANKA LILI'UOKALANI
Entity type:Individual
Prefix:
First Name:IVANKA
Middle Name:LILI'UOKALANI
Last Name:CORONADO
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:PO BOX 2641
Mailing Address - Street 2:
Mailing Address - City:SAN ELIZARIO
Mailing Address - State:TX
Mailing Address - Zip Code:79849-2641
Mailing Address - Country:US
Mailing Address - Phone:915-274-8209
Mailing Address - Fax:
Practice Address - Street 1:10727 GATEWAY BLVD W
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4906
Practice Address - Country:US
Practice Address - Phone:915-593-3164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist