Provider Demographics
NPI:1710005392
Name:CORREA, JORGE ALFONSO (LSA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALFONSO
Last Name:CORREA
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8022 OXBOW MANOR LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-0162
Mailing Address - Country:US
Mailing Address - Phone:713-614-4465
Mailing Address - Fax:832-674-7284
Practice Address - Street 1:8022 OXBOW MANOR LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-0162
Practice Address - Country:US
Practice Address - Phone:713-614-4465
Practice Address - Fax:832-674-7284
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00168363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical