Healthcare Provider Details

I. General information

NPI: 1194530360
Provider Name (Legal Business Name): DESTINY CORLETTO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12912 PHILADELPHIA ST
WHITTIER CA
90601-4119
US

IV. Provider business mailing address

13302 GREENSTONE AVE
NORWALK CA
90650-3338
US

V. Phone/Fax

Practice location:
  • Phone: 951-356-6454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: