Healthcare Provider Details

I. General information

NPI: 1477282499
Provider Name (Legal Business Name): ALEXANDRRA JARANILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E RINCON ST STE 112
CORONA CA
92879-1375
US

IV. Provider business mailing address

255 E RINCON ST STE 112
CORONA CA
92879-1375
US

V. Phone/Fax

Practice location:
  • Phone: 951-816-4228
  • Fax:
Mailing address:
  • Phone: 951-816-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: