Provider Demographics
NPI:1831476340
Name:CORONADO, ISRAEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:
Last Name:CORONADO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S MILE 2 1/2 W
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-0501
Mailing Address - Country:US
Mailing Address - Phone:956-246-7670
Mailing Address - Fax:
Practice Address - Street 1:3636 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0514
Practice Address - Country:US
Practice Address - Phone:928-757-3636
Practice Address - Fax:928-757-3635
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737234367500000X
AZ324558367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered