Healthcare Provider Details

I. General information

NPI: 1053243261
Provider Name (Legal Business Name): CORTICA CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21515 HAWTHORNE BLVD UNIT GL-100
TORRANCE CA
90503-6501
US

IV. Provider business mailing address

21515 HAWTHORNE BLVD UNIT GL-100
TORRANCE CA
90503-6501
US

V. Phone/Fax

Practice location:
  • Phone: 424-571-2618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIAN TELLEZ
Title or Position: BEHAVIOR INTERVENTIONIST
Credential: MASTERS
Phone: 310-941-9277