Provider Demographics
NPI:1669019238
Name:CORTEZ, EDWARDO FRANCISCO (AMFT)
Entity Type:Individual
Prefix:MR
First Name:EDWARDO
Middle Name:FRANCISCO
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 RAMSEY DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1785
Mailing Address - Country:US
Mailing Address - Phone:209-400-1006
Mailing Address - Fax:
Practice Address - Street 1:610 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2505
Practice Address - Country:US
Practice Address - Phone:209-524-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113061106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist