Provider Demographics
NPI:1598541062
Name:COREAS, EMILY (PMHNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:COREAS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:EMIL
Other - Middle Name:
Other - Last Name:CANALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMILY CHRISTENSEN
Mailing Address - Street 1:1450 SAN PABLO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5331
Mailing Address - Country:US
Mailing Address - Phone:310-483-2540
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5331
Practice Address - Country:US
Practice Address - Phone:800-872-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026840363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health