Provider Demographics
NPI:1477003895
Name:CORONA, MAYELA DE JESUS
Entity Type:Individual
Prefix:MS
First Name:MAYELA
Middle Name:DE JESUS
Last Name:CORONA
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 1:4626 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2055
Mailing Address - Country:US
Mailing Address - Phone:626-331-5316
Mailing Address - Fax:626-332-2219
Practice Address - Street 1:4626 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2055
Practice Address - Country:US
Practice Address - Phone:626-331-5316
Practice Address - Fax:626-332-2219
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)