Provider Demographics
NPI:1730795543
Name:BURCH, CORINA ROCHELLE
Entity type:Individual
Prefix:
First Name:CORINA
Middle Name:ROCHELLE
Last Name:BURCH
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 1:8750 MELLMANOR DR APT 30
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3162
Mailing Address - Country:US
Mailing Address - Phone:619-493-6334
Mailing Address - Fax:
Practice Address - Street 1:3706 CALAVO DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1903
Practice Address - Country:US
Practice Address - Phone:619-779-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY9223414OtherDRIVER LICENSE