Provider Demographics
NPI:1245245950
Name:CORREA, ADRIAN JOSE-LUIS (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:JOSE-LUIS
Last Name:CORREA
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-2582
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5331
Practice Address - Country:US
Practice Address - Phone:323-442-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69043207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A690430Medicaid
CA1902846306OtherCORP NPI
CA1952325565OtherGROUP NPI NUMBER
CA00A690430OtherBLUE SHIELD
CAHW7801AMedicare PIN
CA00A690430Medicaid
CAWA69043AMedicare PIN
CAWA69043CMedicare PIN
CAHW7801BMedicare PIN
CA00A690430OtherBLUE SHIELD
CAH58975Medicare UPIN