Healthcare Provider Details

I. General information

NPI: 1053277673
Provider Name (Legal Business Name): AANGELINA ISABEL CORADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 W CLEMMENS LN APT 53
FALLBROOK CA
92028-4088
US

IV. Provider business mailing address

234 W CLEMMENS LN APT 53
FALLBROOK CA
92028-4088
US

V. Phone/Fax

Practice location:
  • Phone: 442-646-7044
  • Fax:
Mailing address:
  • Phone: 442-646-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: