Healthcare Provider Details

I. General information

NPI: 1215411673
Provider Name (Legal Business Name): RAMONA CORTEZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11037 WARNER AVE STE 339
FOUNTAIN VALLEY CA
92708-4007
US

IV. Provider business mailing address

11037 WARNER AVE STE 339
FOUNTAIN VALLEY CA
92708-4007
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-4292
  • Fax: 714-596-6274
Mailing address:
  • Phone: 800-273-4292
  • Fax: 714-596-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-46432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: