Provider Demographics
NPI:1003614744
Name:CORREA, LUIS ABRAHAM (LEP)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ABRAHAM
Last Name:CORREA
Suffix:
Gender:
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 TIBBETTS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-8038
Mailing Address - Country:US
Mailing Address - Phone:951-214-1388
Mailing Address - Fax:
Practice Address - Street 1:528 TIBBETTS ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-8038
Practice Address - Country:US
Practice Address - Phone:951-214-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4338103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool