Healthcare Provider Details

I. General information

NPI: 1851962401
Provider Name (Legal Business Name): MICHAEL CORBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 CHURCH AVE
CHULA VISTA CA
91910-2728
US

IV. Provider business mailing address

41923 2ND ST
TEMECULA CA
92590-2832
US

V. Phone/Fax

Practice location:
  • Phone: 951-676-4193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN95191584
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number61781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: