Basic Information
| Provider Information | |||||||||
| NPI: | 1356697429 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORONA | ||||||||
| FirstName: | MIREYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14535 SHERMAN CIR | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014930 | ||||||||
| FaxNumber: | 8187854118 | ||||||||
| Practice Location | |||||||||
| Address1: | 14535 SHERMAN CIR | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014930 | ||||||||
| FaxNumber: | 8187854118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2012 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | IMF75607 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | 97025 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7420 | 05 | CA | MEDICAID | 7068 | 05 | CA | MEDICAID |