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General NPI Number Information
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NPI Number | 1265900385
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Entity Type | Individual
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Provider Name | CORINA PHAYBOUN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 424 PENINSULA AVE
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City | SAN MATEO
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State | CA
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Zip | 94401-1653
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Country | US
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Telephone | 650-286-4396
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Fax |
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Provider Business Mailing Address
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Address Line | 8888 AMBERJACK WAY
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City | SACRAMENTO
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State | CA
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Zip | 95828-6433
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Country | US
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Telephone | 916-914-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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