MEDICARE: KEVIN R. CORTEZ

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	103K00000X	Behavior Analyst	1-22-58506	TX
2	103K00000X	Behavior Analyst	1-22-58506	CA
3	103K00000X	Behavior Analyst	1-22-58506	NJ

General Provider Information

NPI Number	:	1316688922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN R. CORTEZ

Provider Business Mailing Address
First Line	:	28005 BRADLEY RD STE 105
Second Line	:	UNIT 507
City	:	MENIFEE
State	:	CA
Zip	:	92586-2252
Country	:	US
Telephone Number	:	951-852-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	28005 BRADLEY RD STE 105 UNIT 507
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92586-2252
Country	:	US
Telephone Number	:	951-852-8337
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	06/04/2026

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Directions to “ KEVIN R. CORTEZ ” Practice Location

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