Provider Demographics
NPI:1720886211
Name:CORRAL, MAYRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:CORRAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-8107
Mailing Address - Country:US
Mailing Address - Phone:575-520-4948
Mailing Address - Fax:
Practice Address - Street 1:2955 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-8107
Practice Address - Country:US
Practice Address - Phone:575-520-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula