MEDICARE: CORAZON E LESADA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME24383	FL

General Provider Information

NPI Number	:	1760481972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORAZON E LESADA M.D.

Provider Business Mailing Address
First Line	:	8049 ARLINGTON EXPY
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-6269
Country	:	US
Telephone Number	:	904-721-2670
Fax Number	:	904-721-2670

Provider Business Practice Location Address
First Line	:	8049 ARLINGTON EXPY
Second Line	:	SUITE 4
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-6269
Country	:	US
Telephone Number	:	904-721-2670
Fax Number	:	904-721-2670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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Directions to “ CORAZON E LESADA M.D.” Practice Location

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