Healthcare Provider Details

I. General information

NPI: 1205223849
Provider Name (Legal Business Name): DAMON CHRISTOPHER CORGIAT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 LATHAM ST STE G
RIVERSIDE CA
92501-1737
US

IV. Provider business mailing address

21766 ALVAREZ
MISSION VIEJO CA
92691-1234
US

V. Phone/Fax

Practice location:
  • Phone: 909-295-5805
  • Fax:
Mailing address:
  • Phone: 801-808-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9133595-6010
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY34178
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: