Provider Demographics
NPI:1013767763
Name:CORRAL LOBAINA, DIANELIS
Entity type:Individual
Prefix:
First Name:DIANELIS
Middle Name:
Last Name:CORRAL LOBAINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SW 85TH WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4503
Mailing Address - Country:US
Mailing Address - Phone:786-782-6744
Mailing Address - Fax:
Practice Address - Street 1:301 SW 85TH WAY APT 206
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4503
Practice Address - Country:US
Practice Address - Phone:786-782-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician