Provider Demographics
NPI:1578033080
Name:CORTEZ, ANAHI
Entity Type:Individual
Prefix:
First Name:ANAHI
Middle Name:
Last Name:CORTEZ
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 1:875 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3311
Mailing Address - Country:US
Mailing Address - Phone:209-633-3057
Mailing Address - Fax:
Practice Address - Street 1:875 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3311
Practice Address - Country:US
Practice Address - Phone:209-633-3057
Practice Address - Fax:209-633-3031
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
CAAPCC12281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator