Active NPI
Corey Macedon
- Counselor
- San Jacinto, CA
National Provider Identifier
1053618702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1604 S Santa Fe Ave
Suite 403
San Jacinto, CA 92583-5060 - Phone
- (951) 654-2026
- Fax
- (951) 654-9927
- NPI assigned
- Feb 15, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CA | Primary |
Addresses
Primary practice location
1604 S Santa Fe Ave
Suite 403
San Jacinto, CA 92583-5060
Mailing address
5870 Arlington Ave
Suite 103
Riverside, CA 92504-2037
Phone (951) 683-6596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297728000000",
"number": "1053618702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5870 ARLINGTON AVE",
"address_2": "SUITE 103",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925042037",
"telephone_number": "951-683-6596",
"fax_number": "951-683-4239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1604 S SANTA FE AVE",
"address_2": "SUITE 403",
"city": "SAN JACINTO",
"state": "CA",
"postal_code": "925835060",
"telephone_number": "951-654-2026",
"fax_number": "951-654-9927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACEDON",
"first_name": "COREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-02-15",
"last_updated": "2011-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jacinto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.