1063663136 NPI number — MRS. PATRICIA LORENA CORONEL MS, LMFT

Table of content: MRS. PATRICIA LORENA CORONEL MS, LMFT (NPI 1063663136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063663136 NPI number — MRS. PATRICIA LORENA CORONEL MS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORONEL
Provider First Name:
PATRICIA
Provider Middle Name:
LORENA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEWSOME
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
LORENA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063663136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3125 WINERY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93612-4718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-575-3919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4452 E. KINGS CANYON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-600-6078
Provider Business Practice Location Address Fax Number:
559-600-6090
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  100814 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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