Provider Demographics
NPI:1821679358
Name:CORSHIDI-HORESH, CORRINE DINA
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:DINA
Last Name:CORSHIDI-HORESH
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 1:9135 JUDICIAL DR APT 3536
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4662
Mailing Address - Country:US
Mailing Address - Phone:310-806-3501
Mailing Address - Fax:
Practice Address - Street 1:9135 JUDICIAL DR APT 3536
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4662
Practice Address - Country:US
Practice Address - Phone:310-806-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst