Healthcare Provider Details

I. General information

NPI: 1528587250
Provider Name (Legal Business Name): CORTICA BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

IV. Provider business mailing address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

V. Phone/Fax

Practice location:
  • Phone: 858-758-7842
  • Fax: 858-952-0502
Mailing address:
  • Phone: 858-216-8837
  • Fax: 888-383-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL HATTANGADI
Title or Position: CEO
Credential: MD
Phone: 858-216-8837