Healthcare Provider Details

I. General information

NPI: 1659557965
Provider Name (Legal Business Name): JOSE E CORENA PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6454 VAN NUYS BLVD STE 111
VAN NUYS CA
91401-1445
US

IV. Provider business mailing address

6454 VAN NUYS BLVD STE 111
VAN NUYS CA
91401-1445
US

V. Phone/Fax

Practice location:
  • Phone: 818-336-6441
  • Fax: 818-336-6441
Mailing address:
  • Phone: 818-336-6441
  • Fax: 818-336-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: