Provider Demographics
NPI:1114924446
Name:CORRADA, ROMULO (MD)
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:
Last Name:CORRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 S SPID DR
Mailing Address - Street 2:STE 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4940
Mailing Address - Country:US
Mailing Address - Phone:361-993-6000
Mailing Address - Fax:361-993-3676
Practice Address - Street 1:7121 S SPID DR
Practice Address - Street 2:STE 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4940
Practice Address - Country:US
Practice Address - Phone:361-993-6000
Practice Address - Fax:361-993-3676
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08971207V00000X
TXJ8971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044719501Medicaid
G12698Medicare UPIN