Provider Demographics
NPI:1336823202
Name:ARENAS, KORI MICHELE
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:MICHELE
Last Name:ARENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25716 PALMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7609
Mailing Address - Country:US
Mailing Address - Phone:951-500-1977
Mailing Address - Fax:
Practice Address - Street 1:27192 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7387
Practice Address - Country:US
Practice Address - Phone:951-566-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77412355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant