Healthcare Provider Details

I. General information

NPI: 1942134341
Provider Name (Legal Business Name): SCOPA HAS A DREAM, INC. DBA CORAZON HEALDSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 HEALDSBURG AVE RM 5
HEALDSBURG CA
95448-3260
US

IV. Provider business mailing address

1557 HEALDSBURG AVE RM 5
HEALDSBURG CA
95448-3260
US

V. Phone/Fax

Practice location:
  • Phone: 707-694-7172
  • Fax:
Mailing address:
  • Phone: 707-694-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MARCY FLORES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-615-4567