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General NPI Number Information
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NPI Number | 1801288535
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Entity Type | Organization
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Legal Business Name | CORTICA HEALTHCARE INC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 6160 CORNERSTONE CT E STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-3724
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Country | US
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Telephone | 858-758-7842
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Fax | 858-952-0502
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Provider Business Mailing Address
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Address Line | 6160 CORNERSTONE CT E STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92121-3724
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Country | US
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Telephone | 858-216-8837
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Fax | 888-383-0040
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUZANNE GOH
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Credential | M.D.
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Telephone | 858-216-8837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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