Provider Demographics
NPI:1891128559
Name:CORREA, AIXA
Entity Type:Individual
Prefix:MS
First Name:AIXA
Middle Name:
Last Name:CORREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PASEO NAUTICO
Mailing Address - Street 2:MANSION DEL MAR
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3485
Mailing Address - Country:US
Mailing Address - Phone:787-261-3590
Mailing Address - Fax:
Practice Address - Street 1:83 PASEO NAUTICO
Practice Address - Street 2:MANSION DEL MAR
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3485
Practice Address - Country:US
Practice Address - Phone:787-261-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist