Provider Demographics
NPI:1407492150
Name:CORRAL, TERESA L SR (NURSE)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:CORRAL
Suffix:SR
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 N MAGNOLIA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3995
Mailing Address - Country:US
Mailing Address - Phone:619-401-3914
Mailing Address - Fax:
Practice Address - Street 1:367 N MAGNOLIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3995
Practice Address - Country:US
Practice Address - Phone:619-441-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620476163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health