Healthcare Provider Details

I. General information

NPI: 1720512080
Provider Name (Legal Business Name): MARILYN AUXILIADORA AROSEMENA CORONEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date: 11/17/2017
Reactivation Date: 11/27/2017

III. Provider practice location address

701 S ZARZAMORA ST
SAN ANTONIO TX
78207-5209
US

IV. Provider business mailing address

180 HARVESTER DR STE 110
BURR RIDGE IL
60527-6686
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-7000
  • Fax:
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberU0959
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number125075373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: