Provider Demographics
NPI:1811875339
Name:CORONA ALTUVE, ILEN
Entity type:Individual
Prefix:
First Name:ILEN
Middle Name:
Last Name:CORONA ALTUVE
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 1:3330 NW 48TH TER APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-3377
Mailing Address - Country:US
Mailing Address - Phone:786-660-4728
Mailing Address - Fax:
Practice Address - Street 1:3330 NW 48TH TER APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3377
Practice Address - Country:US
Practice Address - Phone:786-660-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician