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General NPI Number Information
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NPI Number | 1053243261
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Entity Type | Organization
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Legal Business Name | CORTICA CARE
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 21515 HAWTHORNE BLVD UNIT GL-100
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City | TORRANCE
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State | CA
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Zip | 90503-6501
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Country | US
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Telephone | 424-571-2618
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Fax |
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Provider Business Mailing Address
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Address Line | 21515 HAWTHORNE BLVD UNIT GL-100
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City | TORRANCE
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State | CA
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Zip | 90503-6501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR INTERVENTIONIST
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Name | KRISTIAN TELLEZ
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Credential | MASTERS
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Telephone | 310-941-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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