Healthcare Provider Details

I. General information

NPI: 1639746407
Provider Name (Legal Business Name): JESSICA ABISSAY CORRAL-MANGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 SUNDALE AVE
BAKERSFIELD CA
93309-7908
US

IV. Provider business mailing address

5801 SUNDALE AVE
BAKERSFIELD CA
93309-7908
US

V. Phone/Fax

Practice location:
  • Phone: 661-827-3100
  • Fax:
Mailing address:
  • Phone: 661-827-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number123325
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW103413
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: