Healthcare Provider Details

I. General information

NPI: 1427963826
Provider Name (Legal Business Name): ALEXA ESTELA CORRALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 S JOHNSON AVE
EL CAJON CA
92020-5811
US

IV. Provider business mailing address

2430 69TH ST
LEMON GROVE CA
91945-3416
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-4150
  • Fax:
Mailing address:
  • Phone: 619-862-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240083754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: