MEDICARE: NEIL CORREIA MD INC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1962182469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIL CORREIA MD INC

Provider Business Mailing Address
First Line	:	122 PEARWOOD AVE
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2910
Country	:	US
Telephone Number	:	805-540-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	562 CAMINO MERCADO
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1815
Country	:	US
Telephone Number	:	805-410-8971
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEIL J CORREIA
Credential	:	MD
Telephone Number	:	805-540-1306

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/25/2023

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