Provider Demographics
NPI:1114207818
Name:CORREA, ALICIA G (ATP)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:G
Last Name:CORREA
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 JOHN SMITH STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6069
Mailing Address - Country:US
Mailing Address - Phone:210-614-3804
Mailing Address - Fax:210-614-3805
Practice Address - Street 1:7410 JOHN SMITH STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6069
Practice Address - Country:US
Practice Address - Phone:210-614-3804
Practice Address - Fax:210-614-3805
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other