Provider Demographics
NPI:1598806549
Name:CARLOS A CORRALES MD LLC
Entity Type:Organization
Organization Name:CARLOS A CORRALES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-255-9760
Mailing Address - Street 1:10167 NW 31ST ST
Mailing Address - Street 2:STE # 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:954-255-9759
Practice Address - Street 1:10167 NW 31ST ST
Practice Address - Street 2:STE # 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:954-255-9759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI974Medicare PIN