Healthcare Provider Details

I. General information

NPI: 1558934232
Provider Name (Legal Business Name): CORINNE MARIE ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 PHEASANT RUN CIR
JURUPA VALLEY CA
92509-0705
US

IV. Provider business mailing address

6821 PHEASANT RUN CIR
JURUPA VALLEY CA
92509-0705
US

V. Phone/Fax

Practice location:
  • Phone: 626-261-2444
  • Fax: 909-944-2917
Mailing address:
  • Phone: 626-261-2444
  • Fax: 909-944-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: