Provider Demographics
NPI:1972646644
Name:CORRIGAN, TERRANCE MICHAEL
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:MICHAEL
Last Name:CORRIGAN
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 1:5201 RUFFIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1653
Mailing Address - Country:US
Mailing Address - Phone:619-884-9614
Mailing Address - Fax:
Practice Address - Street 1:5201 RUFFIN RD STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1699
Practice Address - Country:US
Practice Address - Phone:858-694-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator