Individual
GUSTAVO A CORRALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
410 S WASHINGTON ST, FALLS CHURCH, VA 22046
(703) 532-0728
(888) 972-9036
Mailing address
410 S WASHINGTON ST, FALLS CHURCH, VA 22046-4412
(703) 532-0728
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
003086
NY
207W00000X
Ophthalmology Physician
MT187242
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650A21
EMPIRE BLUE CROSS BLUE SHIELD
NY
Enumeration date
05/30/2007
Last updated
09/07/2018
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