Healthcare Provider Details

I. General information

NPI: 1851208128
Provider Name (Legal Business Name): PRISCILLA CORONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12968 FREDERICK ST STE A
MORENO VALLEY CA
92553-5229
US

IV. Provider business mailing address

12937 PARADISO DR UNIT 202
EASTVALE CA
92880-3882
US

V. Phone/Fax

Practice location:
  • Phone: 951-242-7738
  • Fax: 951-242-7733
Mailing address:
  • Phone: 951-507-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: