Healthcare Provider Details

I. General information

NPI: 1003363433
Provider Name (Legal Business Name): ADRIANA CORNEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD
BALDWIN PARK CA
91706-3752
US

IV. Provider business mailing address

940 AVENUE 64
PASADENA CA
91105-2711
US

V. Phone/Fax

Practice location:
  • Phone: 626-373-2900
  • Fax:
Mailing address:
  • Phone: 323-543-2800
  • Fax: 323-978-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: