Active NPI
Ileana M Diaz Corujo, MD, PA
- Medical Physician Assistant
- Orlando, FL
National Provider Identifier
1205632999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 2452
- Practice address
- 13148 Summerton Dr
Orlando, FL 32824-6259 - Phone
- (407) 912-6078
- NPI assigned
- Feb 22, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 2452 | PR | Primary |
Addresses
Primary practice location
13148 Summerton Dr
Orlando, FL 32824-6259
Mailing address
13148 Summerton Dr
Orlando, FL 32824-6259
Phone (407) 912-6078
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2452 | PR | MD | Community/Retail Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1740182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740182400000",
"number": "1205632999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13148 SUMMERTON DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328246259",
"telephone_number": "407-912-6078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13148 SUMMERTON DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328246259",
"telephone_number": "407-912-6078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ CORUJO",
"first_name": "ILEANA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD, PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-02-22",
"last_updated": "2025-02-22",
"certification_date": "2025-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PR",
"license": "2452",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.