Provider Demographics
NPI:1902674302
Name:CORONA MENENDEZ, ENRIQUE E
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:E
Last Name:CORONA MENENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4117
Mailing Address - Country:US
Mailing Address - Phone:203-627-6254
Mailing Address - Fax:
Practice Address - Street 1:7709 PAULA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4117
Practice Address - Country:US
Practice Address - Phone:203-627-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician