Provider Demographics
NPI:1710753934
Name:JOHN, GABRIEL CORTIZE JR (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:CORTIZE
Last Name:JOHN
Suffix:JR
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 W SOUTHERN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4244
Mailing Address - Country:US
Mailing Address - Phone:480-999-1190
Mailing Address - Fax:
Practice Address - Street 1:2737 W SOUTHERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4244
Practice Address - Country:US
Practice Address - Phone:480-999-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician