Provider Demographics
NPI:1033725767
Name:CORRALES, PAULINA AMANDA (MED)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:AMANDA
Last Name:CORRALES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 3RD AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5846
Mailing Address - Country:US
Mailing Address - Phone:619-616-8865
Mailing Address - Fax:
Practice Address - Street 1:5050 MURPHY CANYON RD STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4399
Practice Address - Country:US
Practice Address - Phone:619-330-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-44239103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst