Active NPI
Marco A Coronado, PH.D.
- Psychologist
- Glendale, AZ
National Provider Identifier
1104968445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 7301 N 58TH Ave
Glendale, AZ 85301-1893 - Phone
- (623) 842-8148
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | AZ | Primary |
Addresses
Primary practice location
7301 N 58TH Ave
Glendale, AZ 85301-1893
Mailing address
7301 N 58TH Ave
Glendale, AZ 85301-1893
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 686686 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glendale Elementary School District #40 | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Glendale, AZ
- NPI 1811197916
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185408000000",
"number": "1104968445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7301 N 58TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853011893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7301 N 58TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853011893",
"telephone_number": "623-842-8148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORONADO",
"first_name": "MARCO",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AZ",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "686686",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.