Healthcare Provider Details

I. General information

NPI: 1912627159
Provider Name (Legal Business Name): OSCAR CORRAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 COPPER AVE NE
ALBUQUERQUE NM
87108-2068
US

IV. Provider business mailing address

10304 DOCENA PL NW
ALBUQUERQUE NM
87114-4186
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-7296
  • Fax: 505-916-5034
Mailing address:
  • Phone: 520-250-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: