Healthcare Provider Details

I. General information

NPI: 1619411154
Provider Name (Legal Business Name): CORINNE ENOS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9451 INDIANAPOLIS AVE
HUNTINGTON BEACH CA
92646-5955
US

IV. Provider business mailing address

13602 CHARLOMA DR
TUSTIN CA
92780-4503
US

V. Phone/Fax

Practice location:
  • Phone: 714-593-9630
  • Fax:
Mailing address:
  • Phone: 949-633-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: