Provider Demographics
NPI:1073538799
Name:AJERO, CORAZON GLADYS WHITE (MD)
Entity Type:Individual
Prefix:
First Name:CORAZON GLADYS
Middle Name:WHITE
Last Name:AJERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1820
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-1820
Mailing Address - Country:US
Mailing Address - Phone:956-383-7779
Mailing Address - Fax:956-383-3315
Practice Address - Street 1:316 CONQUEST BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-383-7779
Practice Address - Fax:956-383-3315
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM14552080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics