Provider Demographics
NPI:1760978027
Name:NORIEGA, JAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JAEL
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:120 E KENDALL ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-2434
Mailing Address - Country:US
Mailing Address - Phone:323-500-5595
Mailing Address - Fax:
Practice Address - Street 1:1411 RIMPAU AVE STE 109
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-2681
Practice Address - Country:US
Practice Address - Phone:661-299-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT92521101YM0800X
CA119271106H00000X
CALMFT119271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health