Provider Demographics
NPI:1265273320
Name:CORONEL, BRENDA YANETH
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:YANETH
Last Name:CORONEL
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 1:6544 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-3919
Mailing Address - Country:US
Mailing Address - Phone:310-400-6562
Mailing Address - Fax:
Practice Address - Street 1:6737 BRIGHT AVE STE 101
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4313
Practice Address - Country:US
Practice Address - Phone:562-325-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1130231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical