MEDICARE: DR. NEIL JOHN CORREIA M.D.

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	207V00000X	Obstetrics & Gynecology Physician	0101244057	VA
2	207V00000X	Obstetrics & Gynecology Physician	A111405	CA

General Provider Information

NPI Number	:	1316145303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL JOHN CORREIA M.D.

Provider Business Mailing Address
First Line	:	122 PEARWOOD AVE
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-2910
Country	:	US
Telephone Number	:	805-540-1306
Fax Number	:	805-434-9413

Provider Business Practice Location Address
First Line	:	562 CAMINO MERCADO
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1815
Country	:	US
Telephone Number	:	805-410-8971
Fax Number	:	805-291-8003

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/19/2023

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