Provider Demographics
NPI:1538475983
Name:CARDONA ORELLANA, ILIANA L (MD)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:L
Last Name:CARDONA ORELLANA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16620 N US HIGHWAY 281 STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2679
Mailing Address - Country:US
Mailing Address - Phone:210-614-1231
Mailing Address - Fax:210-499-0811
Practice Address - Street 1:4458 MEDICAL DR STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3748
Practice Address - Country:US
Practice Address - Phone:210-614-1515
Practice Address - Fax:210-615-6904
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP8651207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337801001Medicaid
TX337801001Medicaid