Healthcare Provider Details

I. General information

NPI: 1770122012
Provider Name (Legal Business Name): JUANA CORSAUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14140 BEACH BLVD STE 223
WESTMINSTER CA
92683-4453
US

IV. Provider business mailing address

405 W 5TH ST STE 202A
SANTA ANA CA
92701-4522
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-7938
  • Fax:
Mailing address:
  • Phone: 714-834-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: