Provider Demographics
NPI:1326194374
Name:CORREA RODRIGUEZ, MABEL (OTH)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:CORREA RODRIGUEZ
Suffix:
Gender:F
Credentials:OTH
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 360325
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0325
Mailing Address - Country:US
Mailing Address - Phone:787-767-6710
Mailing Address - Fax:787-758-0950
Practice Address - Street 1:URB PEREZ MORRIS
Practice Address - Street 2:CALLE BAEZ # 500
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-767-6710
Practice Address - Fax:787-758-0950
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR61684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist