MEDICARE: ROSA CORTIZO LMFT, PSYD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY22278	CA
2	106H00000X	Marriage & Family Therapist	MFC37949	CA

General Provider Information

NPI Number	:	1952316648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA CORTIZO LMFT, PSYD

Provider Business Mailing Address
First Line	:	8950 VILLA LA JOLLA DR STE C230
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1712
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Provider Business Practice Location Address
First Line	:	8950 VILLA LA JOLLA DR STE C230
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1712
Country	:	US
Telephone Number	:	925-282-1778
Fax Number	:	415-296-5299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	04/15/2024

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