Healthcare Provider Details

I. General information

NPI: 1932608973
Provider Name (Legal Business Name): JOHNNY RAY CORTINAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 EL CAMINO WAY
PALO ALTO CA
94306-4010
US

IV. Provider business mailing address

479 CHESTNUT AVE
MILPITAS CA
95035-3803
US

V. Phone/Fax

Practice location:
  • Phone: 650-617-8340
  • Fax: 408-642-6052
Mailing address:
  • Phone: 408-637-9734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: