Healthcare Provider Details

I. General information

NPI: 1780190652
Provider Name (Legal Business Name): YAEL JEZENIA CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 RICHMOND PKWY STE 201
RICHMOND CA
94806-5878
US

IV. Provider business mailing address

1333 WILLOW PASS RD STE 102
CONCORD CA
94520-5225
US

V. Phone/Fax

Practice location:
  • Phone: 510-778-2816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: