Provider Demographics
NPI:1699466573
Name:CORREA, MARCOS ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:ANTONIO
Last Name:CORREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNITED STATES COAST GUARD 5 C. LA PUNTILLA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00703
Mailing Address - Country:US
Mailing Address - Phone:787-628-1662
Mailing Address - Fax:
Practice Address - Street 1:UNITED STATES COAST GUARD 5 C. LA PUNTILLA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-628-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000370-P.A.171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator