Provider Demographics
NPI:1669472254
Name:CORRO, LUCIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:T
Last Name:CORRO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2930 HILLRISE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4776
Mailing Address - Country:US
Mailing Address - Phone:575-521-0008
Mailing Address - Fax:575-521-0063
Practice Address - Street 1:2930 HILLRISE DR
Practice Address - Street 2:SUITE # 5
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4776
Practice Address - Country:US
Practice Address - Phone:575-521-0008
Practice Address - Fax:575-521-0063
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-06-11
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Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0025207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM49634216Medicaid
NMNM400298Medicare PIN
NM49634216Medicaid
NMG19963Medicare UPIN