MEDICARE: ALEJANDRA CORRAL

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1285164681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRA CORRAL

Provider Business Mailing Address
First Line	:	PO BOX 972777
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79997-2777
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6633 N MESA ST STE 103
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4422
Country	:	US
Telephone Number	:	915-307-4320
Fax Number	:	915-307-4035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	06/18/2017

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Directions to “ ALEJANDRA CORRAL ” Practice Location

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