Provider Demographics
NPI:1497767230
Name:CORRINNA T. TIONGSON, MD, PA
Entity Type:Organization
Organization Name:CORRINNA T. TIONGSON, MD, PA
Other - Org Name:CHILDREN'S CLINIC AT CORNERSTONE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORRINNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:TIONGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-682-6860
Mailing Address - Street 1:2606 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9122
Mailing Address - Country:US
Mailing Address - Phone:956-682-6860
Mailing Address - Fax:956-682-8050
Practice Address - Street 1:2606 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9122
Practice Address - Country:US
Practice Address - Phone:956-682-6860
Practice Address - Fax:956-682-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1206682-01Medicaid
TX1206682-03Medicaid