Individual
JACKELYNE VARGAS CORRALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
390 N EUCLID AVE # 100, UPLAND, CA 91786-6031
(909) 985-1864
Mailing address
832 HERBERT AVE, LOS ANGELES, CA 90063-1738
(323) 427-6376
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
CA
104100000X
Social Worker
Primary
—
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Y7840995
—
CA
Enumeration date
06/08/2021
Last updated
02/20/2026
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