Provider Demographics
NPI:1205581428
Name:KORAZONAZUL, TRUAZUL P
Entity type:Individual
Prefix:
First Name:TRUAZUL
Middle Name:P
Last Name:KORAZONAZUL
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 1:4184 SAINT GEORGE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3042
Mailing Address - Country:US
Mailing Address - Phone:510-423-3606
Mailing Address - Fax:
Practice Address - Street 1:4184 SAINT GEORGE PL
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3042
Practice Address - Country:US
Practice Address - Phone:510-423-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist