MEDICARE: JORGE CORONA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	T0758	TX

General Provider Information

NPI Number	:	1235636671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE CORONA MD

Provider Business Mailing Address
First Line	:	209 S SHADY SHORES DR # 300-177
Second Line	:
City	:	LAKE DALLAS
State	:	TX
Zip	:	75065-2973
Country	:	US
Telephone Number	:	214-536-0873
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 N CARROLL AVE STE 150
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6454
Country	:	US
Telephone Number	:	210-941-2258
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/08/2026

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