Healthcare Provider Details

I. General information

NPI: 1528409232
Provider Name (Legal Business Name): SARAH JACQUELINE RANGEL CORNEJO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11622 EL CAMINO REAL STE 100
SAN DIEGO CA
92130-2051
US

IV. Provider business mailing address

11622 EL CAMINO REAL STE 100
SAN DIEGO CA
92130-2051
US

V. Phone/Fax

Practice location:
  • Phone: 619-695-6246
  • Fax:
Mailing address:
  • Phone: 619-695-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: