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General NPI Number Information
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NPI Number | 1902117591
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Entity Type | Individual
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Provider Name | ANELYS CORREA D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 500 N HIATUS RD SUITE 109
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5213
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Country | US
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Telephone | 954-431-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 300 NW 114TH AVE APT 106
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City | MIAMI
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State | FL
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Zip | 33172-4753
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Country | US
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Telephone | 305-318-8884
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN19129
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License Number State | FL
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