Individual
BLANCA ESTELLA CORRALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
245 E LAKE AVE, WATSONVILLE, CA 95076-4717
(831) 688-5300
Mailing address
241 E LAKE AVE, WATSONVILLE, CA 95076-4717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ91892Z
SANTA CRUZ MEDICARE GROUP PTAN#
—
01
—
ZZZ920692
MEDI-CAL
CA
Enumeration date
04/18/2007
Last updated
01/23/2017
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