Provider Demographics
NPI:1558323485
Name:CORRALES, CARLOS AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:AUGUSTO
Last Name:CORRALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10167 NW 31ST ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6152
Mailing Address - Country:US
Mailing Address - Phone:954-255-9760
Mailing Address - Fax:654-255-9759
Practice Address - Street 1:10167 NW 31ST ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-6152
Practice Address - Country:US
Practice Address - Phone:954-255-9760
Practice Address - Fax:654-255-9759
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263938600Medicaid
FL263938600Medicaid
FL58638AMedicare PIN