Provider Demographics
NPI:1891369377
Name:CORREA, ILIANA
Entity type:Individual
Prefix:MS
First Name:ILIANA
Middle Name:
Last Name:CORREA
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 1:63 GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:63 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9303
Practice Address - Country:US
Practice Address - Phone:805-338-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician