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NPI Code Detail

MEDICARE: TRACI L CORREIA

MEDICARE: TRACI L CORREIA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1083058903
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACI L CORREIA
Provider Business Mailing Address
First Line : 5634 JEREMY WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95212-2867
Country : US
Telephone Number : 209-888-4969
Fax Number :
Provider Business Practice Location Address
First Line : 5634 JEREMY WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95212-2867
Country : US
Telephone Number : 209-888-4969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2013
Last Update Date : 04/22/2013

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Directions to “ TRACI L CORREIA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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