Healthcare Provider Details

I. General information

NPI: 1447304001
Provider Name (Legal Business Name): CORRINE A FAVELA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORRINE A. PORRAS N.P.

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11525 BROOKSHIRE AVE STE 301 ATTN MAGGIE NOLES MS 6160
DOWNEY CA
90241-4982
US

IV. Provider business mailing address

9209 COLIMA RD STE 1000
WHITTIER CA
90605-1813
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-3684
  • Fax: 562-862-7145
Mailing address:
  • Phone: 562-696-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP15844
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN570209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: