Healthcare Provider Details

I. General information

NPI: 1417025412
Provider Name (Legal Business Name): MRS. ALICIA CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PACIFICA AVE
BAY POINT CA
94565-2904
US

IV. Provider business mailing address

1338 REA ANNE DR.
CONCORD CA
94520
US

V. Phone/Fax

Practice location:
  • Phone: 925-458-3216
  • Fax:
Mailing address:
  • Phone: 310-678-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: