Healthcare Provider Details

I. General information

NPI: 1316688922
Provider Name (Legal Business Name): KEVIN R. CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28005 BRADLEY RD STE 105 UNIT 507
MENIFEE CA
92586-2252
US

IV. Provider business mailing address

28005 BRADLEY RD STE 105 UNIT 507
MENIFEE CA
92586-2252
US

V. Phone/Fax

Practice location:
  • Phone: 951-852-8337
  • Fax:
Mailing address:
  • Phone: 951-852-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58506
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58506
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58506
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: