Provider Demographics
NPI:1760499958
Name:TIONGSON, CORRINNA T (MD)
Entity Type:Individual
Prefix:
First Name:CORRINNA
Middle Name:T
Last Name:TIONGSON
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 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3750
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:9011 POTEET JOURDANTON FWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-2124
Practice Address - Country:US
Practice Address - Phone:210-928-4900
Practice Address - Fax:210-928-4940
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1206682-01Medicaid
TX1206682-03Medicaid
TX1206682-03Medicaid