Healthcare Provider Details
I. General information
NPI: 1841016391
Provider Name (Legal Business Name): CORTEX CARE NEUROPSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/02/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4435 E CHANDLER BLVD
PHOENIX AZ
85048-7649
US
IV. Provider business mailing address
PO BOX 93092
PHOENIX AZ
85070-3092
US
V. Phone/Fax
- Phone: 602-551-6044
- Fax: 480-542-2204
- Phone: 903-570-3069
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103G00000X |
| Taxonomy | Clinical Neuropsychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
PELIN
STREBLER
Title or Position: MEMBER/MANAGER
Credential: PHD
Phone: 602-551-6044