Provider Demographics
NPI:1326378548
Name:MIHAILESCU, CORINA LIDIA (MA,)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:LIDIA
Last Name:MIHAILESCU
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1543
Mailing Address - Country:US
Mailing Address - Phone:510-465-0881
Mailing Address - Fax:510-465-5908
Practice Address - Street 1:1820 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1543
Practice Address - Country:US
Practice Address - Phone:510-465-0881
Practice Address - Fax:510-465-5908
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA510173390Medicaid