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General NPI Number Information
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NPI Number | 1184148702
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Entity Type | Individual
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Provider Name | DAGMAR JOMARIE CORREA MS, MT
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | CARR 132 KM 4.5 BARRIO MACANA
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City | GUAYANILLA
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State | PR
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Zip | 00656
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Country | US
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Telephone | 787-630-9149
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 6131
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City | GUAYANILLA
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State | PR
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Zip | 00656-9444
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Country | US
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Telephone | 787-630-9149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 12
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License Number State | PR
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