Provider Demographics
NPI:1801563887
Name:CORONA HARO, KESHIA (SUDRC)
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:CORONA HARO
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HERMOSA CT
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6313
Mailing Address - Country:US
Mailing Address - Phone:619-836-2192
Mailing Address - Fax:
Practice Address - Street 1:106 S C ST STE C
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7339
Practice Address - Country:US
Practice Address - Phone:805-741-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12431101YA0400X
171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator