Healthcare Provider Details

I. General information

NPI: 1730795543
Provider Name (Legal Business Name): CORINA ROCHELLE BURCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 CALAVO DR
SPRING VALLEY CA
91977-1903
US

IV. Provider business mailing address

8750 MELLMANOR DR APT 30
LA MESA CA
91942-3162
US

V. Phone/Fax

Practice location:
  • Phone: 619-779-9058
  • Fax:
Mailing address:
  • Phone: 619-493-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: