Provider Demographics
NPI:1396003281
Name:ATENCIO BOHORQUEZ, DANIELA COROMOTO (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:COROMOTO
Last Name:ATENCIO BOHORQUEZ
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 1:1221 S CONGRESS AVE APT 413
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2405
Mailing Address - Country:US
Mailing Address - Phone:312-806-6630
Mailing Address - Fax:
Practice Address - Street 1:7700 CAT HOLLOW DR STE 103
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5797
Practice Address - Country:US
Practice Address - Phone:512-244-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS61192086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program