MEDICARE: EMILY CORTEZ M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	116302	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	106H00000X	Marriage & Family Therapist	136867	CA

General Provider Information

NPI Number	:	1134606791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY CORTEZ M.A.

Provider Business Mailing Address
First Line	:	16250 VENTURA BLVD STE 465
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4620
Country	:	US
Telephone Number	:	818-906-0406
Fax Number	:	818-981-0649

Provider Business Practice Location Address
First Line	:	23504 LYONS AVE STE 402
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-5777
Country	:	US
Telephone Number	:	818-906-0406
Fax Number	:	818-981-0649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	04/05/2023

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