Provider Demographics
NPI:1871277830
Name:CORONADO, MONICA CHRISTINE (ABOC, NCLEC,LDO)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CHRISTINE
Last Name:CORONADO
Suffix:
Gender:
Credentials:ABOC, NCLEC,LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2605
Mailing Address - Country:US
Mailing Address - Phone:623-845-8731
Mailing Address - Fax:623-845-8733
Practice Address - Street 1:5250 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2605
Practice Address - Country:US
Practice Address - Phone:623-845-8731
Practice Address - Fax:623-845-8733
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLDO003204156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician