Provider Demographics
NPI:1518724525
Name:CORONA, LOURDES NATALIE (MS, LEP, PPS)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:NATALIE
Last Name:CORONA
Suffix:
Gender:F
Credentials:MS, LEP, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1797 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4347
Mailing Address - Country:US
Mailing Address - Phone:925-443-2500
Mailing Address - Fax:
Practice Address - Street 1:1797 FOURTH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4347
Practice Address - Country:US
Practice Address - Phone:925-443-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
CALEP4306103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool