Provider Demographics
NPI:1538345111
Name:RUPERT, CORINNE MARGARET (PHD, PSYD)
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:MARGARET
Last Name:RUPERT
Suffix:
Gender:F
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7724
Mailing Address - Country:US
Mailing Address - Phone:949-488-2648
Mailing Address - Fax:
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7724
Practice Address - Country:US
Practice Address - Phone:949-488-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist