Provider Demographics
NPI:1710580378
Name:CORONA-DESILVA, ALENAH MARIE
Entity type:Individual
Prefix:
First Name:ALENAH
Middle Name:MARIE
Last Name:CORONA-DESILVA
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 1:2601 HILLTOP DR SAN PABLO AVE
Mailing Address - Street 2:917
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-0001
Mailing Address - Country:US
Mailing Address - Phone:510-942-9316
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 133
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2480
Practice Address - Country:US
Practice Address - Phone:510-553-8500
Practice Address - Fax:510-553-8500
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X, 101YM0800X, 3747A0650X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider