Provider Demographics
NPI:1790837367
Name:CORACIDES, ALEXANDER (NMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:CORACIDES
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9188 E SAN SALVADOR DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5562
Mailing Address - Country:US
Mailing Address - Phone:480-292-8877
Mailing Address - Fax:480-292-8868
Practice Address - Street 1:9188 E SAN SALVADOR DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5562
Practice Address - Country:US
Practice Address - Phone:480-292-8877
Practice Address - Fax:480-292-8868
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03720175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMC1070755OtherDEA