Provider Demographics
NPI:1235697756
Name:SKELTON, CORWIN ISAIAH I
Entity Type:Individual
Prefix:
First Name:CORWIN
Middle Name:ISAIAH
Last Name:SKELTON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 DEL MONTE BLVD APT H9
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2335
Mailing Address - Country:US
Mailing Address - Phone:831-620-2442
Mailing Address - Fax:
Practice Address - Street 1:3350 DEL MONTE BLVD APT H9
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2335
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician