Healthcare Provider Details

I. General information

NPI: 1720967029
Provider Name (Legal Business Name): CORINA CRISTINE CANSECO ASW, PPSC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W ELDER ST
FALLBROOK CA
92028-2870
US

IV. Provider business mailing address

400 W ELDER ST
FALLBROOK CA
92028-2870
US

V. Phone/Fax

Practice location:
  • Phone: 760-695-9899
  • Fax:
Mailing address:
  • Phone: 760-695-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number220230556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: