Healthcare Provider Details

I. General information

NPI: 1215070339
Provider Name (Legal Business Name): DOROTHY R CORREIA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/11/2021
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 PENNSYLVANIA AVE STE 200
FAIRFIELD CA
94533-3550
US

IV. Provider business mailing address

131 SUNSET AVE STE E-165
SUISUN CITY CA
94585-6345
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-4180
  • Fax:
Mailing address:
  • Phone: 707-646-4180
  • Fax: 707-646-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: