=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225754948
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LETISHA CORTEZ MS,GC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2022
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 744 BATTLEFIELD BLVD N STE 200
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-549-4403
-----------------------------------------------------
Fax | 757-549-4332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6350 CENTER DR STE 200
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 579-055-5587
-----------------------------------------------------
Fax | 757-213-5762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170300000X
-----------------------------------------------------
Taxonomy Name | Genetic Counselor (M.S.)
-----------------------------------------------------
License Number | 0139000778
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------