Provider Demographics
NPI:1871272815
Name:CORREA ORELLANA, KELLY KARINA
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KARINA
Last Name:CORREA ORELLANA
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 1:8102 ARTESIA BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2575
Mailing Address - Country:US
Mailing Address - Phone:562-276-8346
Mailing Address - Fax:
Practice Address - Street 1:8102 ARTESIA BLVD APT 306
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2575
Practice Address - Country:US
Practice Address - Phone:562-276-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician