MEDICARE: CATALINA CORREA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558831263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATALINA CORREA

Provider Business Mailing Address
First Line	:	390 UNION BLVD STE 300
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-6514
Country	:	US
Telephone Number	:	303-989-8172
Fax Number	:	303-984-4366

Provider Business Practice Location Address
First Line	:	1652 W TEXAS ST STE 244
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5952
Country	:	US
Telephone Number	:	925-462-2281
Fax Number	:

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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Directions to “ CATALINA CORREA ” Practice Location

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