Healthcare Provider Details

I. General information

NPI: 1972922714
Provider Name (Legal Business Name): CORTICARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 PRIESTLY DR STE 306
CARLSBAD CA
92008-8825
US

IV. Provider business mailing address

5963 LA PLACE CT STE 309
CARLSBAD CA
92008-8823
US

V. Phone/Fax

Practice location:
  • Phone: 888-482-2334
  • Fax: 888-482-2334
Mailing address:
  • Phone: 888-482-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ROE
Title or Position: CEO
Credential:
Phone: 760-270-9198