Healthcare Provider Details

I. General information

NPI: 1760099972
Provider Name (Legal Business Name): TERESA CORRAL DEULOFEU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 FOREST HILL BLVD STE 3B
WEST PALM BEACH FL
33406-6031
US

IV. Provider business mailing address

3648 PINEHURST DR APT C
LAKE WORTH FL
33467-0908
US

V. Phone/Fax

Practice location:
  • Phone: 561-506-3665
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-255-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: