Provider Demographics
NPI:1336302173
Name:CORONA, RITA ESMERALDA (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ESMERALDA
Last Name:CORONA
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 1:4009 19TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1003
Mailing Address - Country:US
Mailing Address - Phone:806-778-0764
Mailing Address - Fax:
Practice Address - Street 1:4009 19TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1003
Practice Address - Country:US
Practice Address - Phone:806-778-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0032625390200000X
TXP1536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program