Active NPI
Evelyn Coronado
- Pediatric Nutrition Registered Dietitian
- Phoenix, AZ
National Provider Identifier
1295259075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nutrition Registered Dietitian
- Practice address
- 635 E Baseline Rd
Phoenix, AZ 85042-6551 - Phone
- (602) 243-7277
- NPI assigned
- Aug 2, 2017
- Last updated
- Aug 2, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | Primary |
Addresses
Primary practice location
635 E Baseline Rd
Phoenix, AZ 85042-6551
Mailing address
2351 W Desiree LN
Tempe, AZ 85282-6128
Phone (928) 210-9124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Park Health Center | Current | Accepting new patients | |
| Mountain Park Health Center | Current | Accepting new patients |
Locations
3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Phone (602) 323-3492
303 E Baseline Rd
Phoenix, AZ 85042
Phone (602) 277-6181
635 E Baseline Rd
Phoenix, AZ 85042
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1558308825
-
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1386452415
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501632000000",
"number": "1295259075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2351 W DESIREE LN",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852826128",
"telephone_number": "928-210-9124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 E BASELINE RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850426551",
"telephone_number": "602-243-7277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORONADO",
"first_name": "EVELYN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-02",
"last_updated": "2017-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.