Provider Demographics
NPI:1063004166
Name:CORREA PRIMARY CARE INC
Entity Type:Organization
Organization Name:CORREA PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-628-1886
Mailing Address - Street 1:5118 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4757
Mailing Address - Country:US
Mailing Address - Phone:832-628-1886
Mailing Address - Fax:
Practice Address - Street 1:5118 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-4757
Practice Address - Country:US
Practice Address - Phone:832-628-1886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty