Provider Demographics
NPI:1225207319
Name:CARLOS F. CORRALES, D.O., P.A.
Entity Type:Organization
Organization Name:CARLOS F. CORRALES, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:954-726-1808
Mailing Address - Street 1:16855 NE 2ND AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-653-8566
Mailing Address - Fax:305-653-4055
Practice Address - Street 1:16855 NE 2ND AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-653-8566
Practice Address - Fax:305-653-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0002969207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS0002969OtherMEDICAL LICENSE
FLE96454Medicare UPIN
FLOS0002969OtherMEDICAL LICENSE