Healthcare Provider Details

I. General information

NPI: 1992451330
Provider Name (Legal Business Name): CORRI FLINT BEHAVIOR TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 BEACH BLVD
STANTON CA
90680-3939
US

IV. Provider business mailing address

19265 ALLEGHENY RD APT 6
APPLE VALLEY CA
92307-2570
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0118
  • Fax:
Mailing address:
  • Phone: 760-475-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: