Healthcare Provider Details

I. General information

NPI: 1265570337
Provider Name (Legal Business Name): JULIO FRANCISCO CORREA D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 CALLE YANGTZE R.P. HEIGHTS
SAN JUAN PR
00926-3152
US

IV. Provider business mailing address

1725 CALLE YANGTZE R.P. HEIGHTS
SAN JUAN PR
00926-3152
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-5124
  • Fax: 787-758-5120
Mailing address:
  • Phone: 787-758-5124
  • Fax: 787-758-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1770
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: