Healthcare Provider Details

I. General information

NPI: 1366828873
Provider Name (Legal Business Name): KARLA CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 02/20/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17046 MARYGOLD AVE
FONTANA CA
92335-1722
US

IV. Provider business mailing address

1950 S SUNWEST LN
SAN BERNARDINO CA
92408-3258
US

V. Phone/Fax

Practice location:
  • Phone: 866-205-3595
  • Fax:
Mailing address:
  • Phone: 909-252-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: