Healthcare Provider Details

I. General information

NPI: 1205162708
Provider Name (Legal Business Name): MR. CURTIS CORRAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E CENTER ST
ANAHEIM CA
92805-3457
US

IV. Provider business mailing address

320 N VALENCIA ST
LA HABRA CA
90631-4852
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-0750
  • Fax:
Mailing address:
  • Phone: 562-360-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: