Provider Demographics
NPI:1609393354
Name:CORREDERA MAYO, ANGEL A
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:A
Last Name:CORREDERA MAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SW 70TH AVE LOT C340
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4669
Mailing Address - Country:US
Mailing Address - Phone:786-309-0210
Mailing Address - Fax:
Practice Address - Street 1:1040 SW 70TH AVE LOT C340
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4669
Practice Address - Country:US
Practice Address - Phone:786-309-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician