Provider Demographics
NPI:1063995900
Name:CORRALES, CAROL YOSELIN
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:YOSELIN
Last Name:CORRALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17594 E WHITAKER DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2048
Mailing Address - Country:US
Mailing Address - Phone:720-595-7911
Mailing Address - Fax:
Practice Address - Street 1:791 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7112
Practice Address - Country:US
Practice Address - Phone:720-595-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty