Provider Demographics
NPI:1417204595
Name:CORRAL, NATALIE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
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 1:1731 W BULLARD AVE
Mailing Address - Street 2:STE 128
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2372
Mailing Address - Country:US
Mailing Address - Phone:559-478-4691
Mailing Address - Fax:559-412-4119
Practice Address - Street 1:1731 W BULLARD AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2372
Practice Address - Country:US
Practice Address - Phone:559-478-4691
Practice Address - Fax:559-412-4119
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6411800001Medicare NSC