Provider Demographics
NPI:1598300014
Name:CORREDOR MEDINA, MARIA DEL PILAR
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL PILAR
Last Name:CORREDOR MEDINA
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:PO BOX 270652
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-0652
Mailing Address - Country:US
Mailing Address - Phone:844-455-7246
Mailing Address - Fax:813-962-0343
Practice Address - Street 1:2309 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6441
Practice Address - Country:US
Practice Address - Phone:844-455-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93312225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist