Healthcare Provider Details

I. General information

NPI: 1881340388
Provider Name (Legal Business Name): YESSICA PRISCILA MEDRANO CORONA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 N ARROWHEAD AVE STE 100
SAN BERNARDINO CA
92401-1217
US

IV. Provider business mailing address

572 N ARROWHEAD AVE STE 100
SAN BERNARDINO CA
92401-1217
US

V. Phone/Fax

Practice location:
  • Phone: 909-781-1754
  • Fax: 909-266-2790
Mailing address:
  • Phone: 909-781-1754
  • Fax: 909-266-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: