MEDICARE: ANGEL LUIS LABOY CORALES

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	390200000X	Student in an Organized Health Care Education/Training Program		AL

General Provider Information

NPI Number	:	1619796893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL LUIS LABOY CORALES

Provider Business Mailing Address
First Line	:	2000 2ND AVE S APT 303
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-2073
Country	:	US
Telephone Number	:	787-934-3676
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 2ND AVE S APT 303
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-2073
Country	:	US
Telephone Number	:	787-934-3676
Fax Number	:

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

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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Directions to “ ANGEL LUIS LABOY CORALES ” Practice Location

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