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NPI Code Detail

MEDICARE: DR. DAMON CHRISTOPHER CORGIAT PH.D.

MEDICARE: DR. DAMON CHRISTOPHER CORGIAT PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor9133595-6010UT
2103G00000XClinical Neuropsychologist
3103TC0700XClinical PsychologistPSY34178CA

General Provider Information

NPI Number : 1205223849
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAMON CHRISTOPHER CORGIAT PH.D.
Provider Business Mailing Address
First Line : 21766 ALVAREZ
Second Line :
City : MISSION VIEJO
State : CA
Zip : 92691-1234
Country : US
Telephone Number : 801-808-7435
Fax Number :
Provider Business Practice Location Address
First Line : 8300 UTICA AVE STE 245
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-3852
Country : US
Telephone Number : 909-989-4055
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2015
Last Update Date : 08/23/2024

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