Provider Demographics
NPI:1215070339
Name:CORREIA, DOROTHY R (NP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:CORREIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SUNSET AVE STE E-165
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-6345
Mailing Address - Country:US
Mailing Address - Phone:707-646-4180
Mailing Address - Fax:707-646-4185
Practice Address - Street 1:1860 PENNSYLVANIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3550
Practice Address - Country:US
Practice Address - Phone:707-646-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ951584Medicaid
AZ120938Medicare UPIN
AZQ50039Medicare UPIN
AZ104851Medicare ID - Type UnspecifiedMCARE