Healthcare Provider Details

I. General information

NPI: 1508503061
Provider Name (Legal Business Name): ELMA CORONA M.S.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6634 NEW SULPHUR SPRINGS RD
SAN ANTONIO TX
78263-2500
US

IV. Provider business mailing address

6575 COOKSEY RD
ADKINS TX
78101-2244
US

V. Phone/Fax

Practice location:
  • Phone: 210-648-7861
  • Fax:
Mailing address:
  • Phone: 210-632-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15776
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: