Provider Demographics
NPI:1417465303
Name:CORBALA PARRA, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CORBALA PARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 GOLDEN SKY WAY UNIT 138
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8844
Mailing Address - Country:US
Mailing Address - Phone:619-862-4108
Mailing Address - Fax:
Practice Address - Street 1:4650 GOLDEN SKY WAY UNIT 138
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8844
Practice Address - Country:US
Practice Address - Phone:619-862-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst