Healthcare Provider Details

I. General information

NPI: 1720654718
Provider Name (Legal Business Name): MS. ANABEL CORONA LARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 6TH ST STE 230
SAN PEDRO CA
90731-3332
US

IV. Provider business mailing address

1360 W 6TH ST STE 205
SAN PEDRO CA
90732-3567
US

V. Phone/Fax

Practice location:
  • Phone: 310-833-3135
  • Fax: 310-707-2877
Mailing address:
  • Phone: 310-833-3135
  • Fax: 310-707-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW142027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW142027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: