Healthcare Provider Details

I. General information

NPI: 1114633302
Provider Name (Legal Business Name): ITZELT MARICRUZ CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ITZELT MARICRUZ CORTEZ

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

IV. Provider business mailing address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8850
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax:
Mailing address:
  • Phone: 530-822-7200
  • Fax: 530-822-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number139649
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: