Provider Demographics
NPI:1215267505
Name:CORREA, JOSE ORLANDO (6356)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ORLANDO
Last Name:CORREA
Suffix:
Gender:M
Credentials:6356
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2318
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-2318
Mailing Address - Country:US
Mailing Address - Phone:787-384-1476
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA CATALINA #104
Practice Address - Street 2:BO HATO ABAJO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-384-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6356183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician