Provider Demographics
NPI:1194464404
Name:CORONA, AILEEN
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:CORONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AILEEN
Other - Middle Name:JEZEL
Other - Last Name:CORONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3255 OLD CONEJO RD
Mailing Address - Street 2:SUIT 202
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2153
Mailing Address - Country:US
Mailing Address - Phone:805-254-6249
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:3255 OLD CONEJO RD STE 202
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:91320-2153
Practice Address - Country:US
Practice Address - Phone:805-254-6249
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician