Healthcare Provider Details

I. General information

NPI: 1740819036
Provider Name (Legal Business Name): MARILHIA CAROLINA CORNEJO LEON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE STE 101
MEMPHIS TN
38104-3507
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-3500
  • Fax: 901-624-2961
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number71070
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number71070
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: