Healthcare Provider Details

I. General information

NPI: 1942014667
Provider Name (Legal Business Name): CHRISTINE CHEN CORCORAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 EAGLE ROCK BLVD STE 205
LOS ANGELES CA
90041-2087
US

IV. Provider business mailing address

5015 EAGLE ROCK BLVD STE 205
LOS ANGELES CA
90041-2087
US

V. Phone/Fax

Practice location:
  • Phone: 747-300-7541
  • Fax: 818-471-4287
Mailing address:
  • Phone: 747-300-7541
  • Fax: 818-471-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: