Provider Demographics
NPI:1629945688
Name:CORONA CIRCLE PSYCHIATRY MENTAL HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:CORONA CIRCLE PSYCHIATRY MENTAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GICHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-719-3112
Mailing Address - Street 1:765 N MAIN ST STE 152
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-1440
Mailing Address - Country:US
Mailing Address - Phone:626-719-3112
Mailing Address - Fax:
Practice Address - Street 1:765 N MAIN ST STE 152
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-1440
Practice Address - Country:US
Practice Address - Phone:626-719-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty