Healthcare Provider Details

I. General information

NPI: 1538475983
Provider Name (Legal Business Name): ILIANA L CARDONA ORELLANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4458 MEDICAL DR STE 205
SAN ANTONIO TX
78229-3748
US

IV. Provider business mailing address

16620 N US HIGHWAY 281 STE 300
SAN ANTONIO TX
78232-2679
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-1515
  • Fax: 210-615-6904
Mailing address:
  • Phone: 210-614-1231
  • Fax: 210-499-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberP8651
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: