MEDICARE: DOROTHY R CORREIA N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	20514	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215070339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY R CORREIA N.P.

Provider Business Mailing Address
First Line	:	131 SUNSET AVE STE E-165
Second Line	:
City	:	SUISUN CITY
State	:	CA
Zip	:	94585-6345
Country	:	US
Telephone Number	:	707-646-4180
Fax Number	:	707-646-4185

Provider Business Practice Location Address
First Line	:	1860 PENNSYLVANIA AVE STE 200
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3550
Country	:	US
Telephone Number	:	707-646-4180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	01/11/2021

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Directions to “ DOROTHY R CORREIA N.P.” Practice Location

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