Healthcare Provider Details

I. General information

NPI: 1902392954
Provider Name (Legal Business Name): DFW RHEUMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 SE EVERETT MALL WAY STE 400
EVERETT WA
98208-3700
US

IV. Provider business mailing address

15301 SPECTRUM DR STE 330
ADDISON TX
75001-6462
US

V. Phone/Fax

Practice location:
  • Phone: 833-696-3349
  • Fax: 972-499-9210
Mailing address:
  • Phone: 833-696-3349
  • Fax: 972-499-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CORONADO
Title or Position: VP OF MANAGED CARE
Credential:
Phone: 833-696-3349