Provider Demographics
NPI:1003684093
Name:CORONA, TERESA STEPHANIE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:STEPHANIE
Last Name:CORONA
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 1:707 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5125
Mailing Address - Country:US
Mailing Address - Phone:619-381-8093
Mailing Address - Fax:619-346-4536
Practice Address - Street 1:1250 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4300
Practice Address - Country:US
Practice Address - Phone:619-381-8093
Practice Address - Fax:619-346-4536
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker