Provider Demographics
NPI:1689612061
Name:LLARENA, CORAZON LEDESMA (MD)
Entity Type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:LEDESMA
Last Name:LLARENA
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 1:10611 GARLAND RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2666
Mailing Address - Country:US
Mailing Address - Phone:214-321-4231
Mailing Address - Fax:214-327-1684
Practice Address - Street 1:10611 GARLAND RD
Practice Address - Street 2:SUITE 114
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2666
Practice Address - Country:US
Practice Address - Phone:214-321-4231
Practice Address - Fax:214-327-1684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GP64OtherBLUE CROSS BLUE SHIELD
TX033647101Medicaid
TXB24426Medicare UPIN
TX033647101Medicaid