Provider Demographics
NPI:1144985862
Name:CORRALES, LUIS JAIME (MSN-ED, RN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JAIME
Last Name:CORRALES
Suffix:
Gender:M
Credentials:MSN-ED, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2044
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-0044
Mailing Address - Country:US
Mailing Address - Phone:562-233-0852
Mailing Address - Fax:
Practice Address - Street 1:1775 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-1674
Practice Address - Country:US
Practice Address - Phone:562-599-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse