Provider Demographics
NPI:1689191843
Name:CORONA, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
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 1:1012 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2170
Mailing Address - Country:US
Mailing Address - Phone:760-788-9724
Mailing Address - Fax:760-788-9754
Practice Address - Street 1:1012 MAIN STREET STE. 101
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065
Practice Address - Country:US
Practice Address - Phone:760-788-9724
Practice Address - Fax:760-788-9754
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health