MEDICARE: DR. IRMA CORRAL PH.D

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	103TC0700X	Clinical Psychologist	102901	NC
2	103TH0004X	Health Psychologist	102901	NC
3	103TC0700X	Clinical Psychologist	PY1095	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	16474	OTHER	NC	BCBS NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841503091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRMA CORRAL PH.D

Provider Business Mailing Address
First Line	:	3016 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 E CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6681
Country	:	US
Telephone Number	:	702-968-4000
Fax Number	:

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	06/19/2023

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