Healthcare Provider Details

I. General information

NPI: 1265357628
Provider Name (Legal Business Name): DAVID CORREA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 COUNTRY GROVE WAY
HEMET CA
92545-8026
US

IV. Provider business mailing address

4715 COUNTRY GROVE WAY
HEMET CA
92545-8026
US

V. Phone/Fax

Practice location:
  • Phone: 323-229-1739
  • Fax:
Mailing address:
  • Phone: 323-229-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: