Provider Demographics
NPI:1578202214
Name:CORREA, LOURDES M (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:CORREA
Suffix:
Gender:F
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 196
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0196
Mailing Address - Country:US
Mailing Address - Phone:787-737-4333
Mailing Address - Fax:787-737-5022
Practice Address - Street 1:104 CALLE SANTIAGO N
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2441
Practice Address - Country:US
Practice Address - Phone:787-737-4333
Practice Address - Fax:787-737-5022
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22737208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice