MEDICARE: CORTICA ABA THERAPIES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
3	2080P0006X	Developmental - Behavioral Pediatrics Physician
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1942888508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORTICA ABA THERAPIES PA

Provider Business Mailing Address
First Line	:	6160 CORNERSTONE CT E STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3724
Country	:	US
Telephone Number	:	858-216-8837
Fax Number	:	888-383-0040

Provider Business Practice Location Address
First Line	:	5025 W PARK BLVD STE 300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-2585
Country	:	US
Telephone Number	:	972-665-8484
Fax Number	:	469-409-4557

Authorized Official
Title or Position	:	OWNER/CHIEF MEDICAL OFFICER
Name	:	SUZANNE GOH-HATTANGADI
Credential	:	MD
Telephone Number	:	858-216-8837

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	09/15/2025

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