Healthcare Provider Details

I. General information

NPI: 1619572005
Provider Name (Legal Business Name): KRISTAL CORONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

IV. Provider business mailing address

316 7TH ST
HUNTINGTON BEACH CA
92648-4607
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-4272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: