=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841016391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORTEX CARE NEUROPSYCHOLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4435 E CHANDLER BLVD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85048-7649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-551-6044
-----------------------------------------------------
Fax | 480-542-2204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 93092
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85070-3092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-570-3069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/MANAGER
-----------------------------------------------------
Name | PELIN STREBLER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 602-551-6044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------