Provider Demographics
NPI:1225702574
Name:CORRAL, CARLIN JANE
Entity Type:Individual
Prefix:
First Name:CARLIN
Middle Name:JANE
Last Name:CORRAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 E SHAW ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1640
Mailing Address - Country:US
Mailing Address - Phone:949-910-8105
Mailing Address - Fax:
Practice Address - Street 1:4413 E SHAW ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1640
Practice Address - Country:US
Practice Address - Phone:949-910-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer