Provider Demographics
NPI:1912627159
Name:CORRAL, OSCAR
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:CORRAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10304 DOCENA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4186
Mailing Address - Country:US
Mailing Address - Phone:520-250-7649
Mailing Address - Fax:
Practice Address - Street 1:7401 COPPER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2068
Practice Address - Country:US
Practice Address - Phone:505-312-7296
Practice Address - Fax:505-916-5034
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker