MEDICARE: KATHERINE CORTEZ MFT

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	MFC35418	CA

General Provider Information

NPI Number	:	1346319258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE CORTEZ MFT

Provider Business Mailing Address
First Line	:	600 S SAN VICENTE BLVD STE D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4653
Country	:	US
Telephone Number	:	323-655-1692
Fax Number	:	323-655-5832

Provider Business Practice Location Address
First Line	:	600 S SAN VICENTE BLVD STE D
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4653
Country	:	US
Telephone Number	:	323-655-1692
Fax Number	:	323-655-5832

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	10/07/2008

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