Provider Demographics
NPI:1184148702
Name:CORREA, DAGMAR JOMARIE (MS, MT)
Entity type:Individual
Prefix:
First Name:DAGMAR
Middle Name:JOMARIE
Last Name:CORREA
Suffix:
Gender:F
Credentials:MS, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6131
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9444
Mailing Address - Country:US
Mailing Address - Phone:787-630-9149
Mailing Address - Fax:
Practice Address - Street 1:CARR 132 KM 4.5
Practice Address - Street 2:BARRIO MACANA
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656
Practice Address - Country:US
Practice Address - Phone:787-630-9149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory