Provider Demographics
NPI:1467844001
Name:CORTES, GRACIELA
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73350 EL PASEO
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4240
Mailing Address - Country:US
Mailing Address - Phone:760-340-0294
Mailing Address - Fax:
Practice Address - Street 1:73350 EL PASEO
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4240
Practice Address - Country:US
Practice Address - Phone:760-340-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health