Healthcare Provider Details

I. General information

NPI: 1962126599
Provider Name (Legal Business Name): RAFAEL CORRAL BA PSYCHOLOGY, BCAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 200
WOODLAND HILLS CA
91367-4971
US

IV. Provider business mailing address

5690 LAKE MURRAY BLVD APT 14
LA MESA CA
91942-1916
US

V. Phone/Fax

Practice location:
  • Phone: 619-484-7954
  • Fax:
Mailing address:
  • Phone: 619-484-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1262840494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: