MEDICARE: DR. LUCIA T CORRO MD

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	207RN0300X	Nephrology Physician	MD2004-0025	NM

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	:	1669472254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIA T CORRO MD

Provider Business Mailing Address
First Line	:	2930 HILLRISE DR
Second Line	:	SUITE 5
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4776
Country	:	US
Telephone Number	:	575-521-0008
Fax Number	:	575-521-0063

Provider Business Practice Location Address
First Line	:	2930 HILLRISE DR
Second Line	:	SUITE # 5
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4776
Country	:	US
Telephone Number	:	575-521-0008
Fax Number	:	575-521-0063

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	06/11/2010

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