Healthcare Provider Details

I. General information

NPI: 1598327488
Provider Name (Legal Business Name): EVELYN CORRAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 STONERIDGE MALL RD STE 205
PLEASANTON CA
94588-3347
US

IV. Provider business mailing address

610 SAN JOAQUIN DR
VALLEJO CA
94590-7313
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 510-860-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: