MEDICARE: CORY PURSER

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
1	103TS0200X	School Psychologist	240175024	CA

General Provider Information

NPI Number	:	1487500120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY PURSER

Provider Business Mailing Address
First Line	:	1108 BISSELL AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94801-3135
Country	:	US
Telephone Number	:	510-231-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 KEARNEY ST
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3108
Country	:	US
Telephone Number	:	510-231-1448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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