Provider Demographics
NPI:1346828084
Name:CORONA, KOREY
Entity Type:Individual
Prefix:
First Name:KOREY
Middle Name:
Last Name:CORONA
Suffix:
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 1:4050 W. METROPOLITAN DR.
Mailing Address - Street 2:STE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:949-543-6950
Mailing Address - Fax:888-403-6922
Practice Address - Street 1:4050 W. METROPOLITAN DR.
Practice Address - Street 2:STE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:949-543-6950
Practice Address - Fax:888-403-6922
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician