Provider Demographics
NPI:1629111240
Name:CORRALES, BEATRIZ (PA-C)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:CORRALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3804
Mailing Address - Country:US
Mailing Address - Phone:561-752-8000
Mailing Address - Fax:561-752-8001
Practice Address - Street 1:1054 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8301
Practice Address - Country:US
Practice Address - Phone:561-738-4770
Practice Address - Fax:561-738-9727
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102124363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC595YOtherMEDICARE PTAN