Healthcare Provider Details

I. General information

NPI: 1972286060
Provider Name (Legal Business Name): GABRIELA CORTEZ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8272 20TH ST
WESTMINSTER CA
92683-3238
US

IV. Provider business mailing address

8272 20TH ST
WESTMINSTER CA
92683-3238
US

V. Phone/Fax

Practice location:
  • Phone: 714-594-8719
  • Fax:
Mailing address:
  • Phone: 714-594-8719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number34108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: