Healthcare Provider Details

I. General information

NPI: 1689612061
Provider Name (Legal Business Name): CORAZON LEDESMA LLARENA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10611 GARLAND RD SUITE 114
DALLAS TX
75218-2666
US

IV. Provider business mailing address

10611 GARLAND RD SUITE 114
DALLAS TX
75218-2666
US

V. Phone/Fax

Practice location:
  • Phone: 214-321-4231
  • Fax: 214-327-1684
Mailing address:
  • Phone: 214-321-4231
  • Fax: 214-327-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG8544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: