Provider Demographics
NPI:1952613465
Name:CORAL MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:CORAL MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:214-244-6171
Mailing Address - Street 1:9102 GARLAND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3901
Mailing Address - Country:US
Mailing Address - Phone:214-244-6171
Mailing Address - Fax:972-262-8311
Practice Address - Street 1:9102 GARLAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3901
Practice Address - Country:US
Practice Address - Phone:214-244-6171
Practice Address - Fax:972-262-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02353207Q00000X
TXK5697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty