Provider Demographics
NPI:1376735340
Name:FRANCISCO J. CORREA, M.D., INC
Entity Type:Organization
Organization Name:FRANCISCO J. CORREA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:310-802-3219
Mailing Address - Street 1:1350 WEST 6TH ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:310-241-1000
Mailing Address - Fax:310-241-0086
Practice Address - Street 1:1350 W. 6TH ST
Practice Address - Street 2:#3
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:310-241-1000
Practice Address - Fax:310-241-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73565208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24611Medicare UPIN