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NPI Code Detail

MEDICARE: MICHAEL CORRADINO PHD

MEDICARE: MICHAEL CORRADINO PHD
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 CounselorPSY7448CA
2103TC0700XClinical PsychologistPSY7448CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PSY7448OTHERCAPSYCHOLOGIST

General Provider Information

NPI Number : 1437280179
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL CORRADINO PHD
Provider Business Mailing Address
First Line : 8836 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-4832
Country : US
Telephone Number : 323-751-3026
Fax Number : 323-751-3424
Provider Business Practice Location Address
First Line : 8836 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-4832
Country : US
Telephone Number : 323-751-3026
Fax Number : 323-751-3424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 06/18/2013

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