Healthcare Provider Details

I. General information

NPI: 1043910508
Provider Name (Legal Business Name): CORINNA D. BYNUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BUCKMAN SPRINGS RD
CAMPO CA
91906-2022
US

IV. Provider business mailing address

1777 BUCKMAN SPRINGS RD
CAMPO CA
91906-2022
US

V. Phone/Fax

Practice location:
  • Phone: 619-478-5696
  • Fax:
Mailing address:
  • Phone: 707-826-8633
  • Fax: 619-478-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN95177050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: