Healthcare Provider Details

I. General information

NPI: 1659381432
Provider Name (Legal Business Name): JOSE JULIO CORREA CARRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE JOSE CELSO BARBOSA S
CAYEY PR
00736-4726
US

IV. Provider business mailing address

55 CALLE JOSE CELSO BARBOSA S
CAYEY PR
00736-4726
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-3088
  • Fax: 787-738-0551
Mailing address:
  • Phone: 787-738-3088
  • Fax: 787-738-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9365
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: