Provider Demographics
NPI:1194044735
Name:CORTINA, RAFAEL (MFT, MBA)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:CORTINA
Suffix:
Gender:M
Credentials:MFT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 SHOREHAM PL STE 175
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5925
Mailing Address - Country:US
Mailing Address - Phone:619-800-1790
Mailing Address - Fax:858-352-6337
Practice Address - Street 1:5151 SHOREHAM PL STE 175
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5925
Practice Address - Country:US
Practice Address - Phone:619-800-1790
Practice Address - Fax:858-352-6337
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194044735Medicaid