Healthcare Provider Details

I. General information

NPI: 1336846278
Provider Name (Legal Business Name): LUIS CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 S RANCHO SANTA FE RD STE 205
SAN MARCOS CA
92078-2338
US

IV. Provider business mailing address

8030 LA MESA BLVD STE 25
LA MESA CA
91942-0335
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-258010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: