MEDICARE: EVELYN MARINA 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	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1366386096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN MARINA CORTEZ

Provider Business Mailing Address
First Line	:	3680 E IMPERIAL HWY STE 220
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 E IMPERIAL HWY STE 220
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2663
Country	:	US
Telephone Number	:	323-769-7174
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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