Healthcare Provider Details

I. General information

NPI: 1982979282
Provider Name (Legal Business Name): CONNEXIONS MEDICAL DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E PLANO PKWY STE 115
PLANO TX
75074-6751
US

IV. Provider business mailing address

701 E PLANO PKWY STE 115
PLANO TX
75074-6751
US

V. Phone/Fax

Practice location:
  • Phone: 972-801-8051
  • Fax:
Mailing address:
  • Phone: 972-801-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number261QM2500X
License Number StateTX

VIII. Authorized Official

Name: PAULA CALL CORNEJO
Title or Position: PRESIDENT
Credential: R.EEG.T
Phone: 972-801-8051