Provider Demographics
NPI:1790157287
Name:CORTEZ, MERCEDES (ACSW 69323)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:ACSW 69323
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 SAN FERNANDO RD APT 319
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-7756
Mailing Address - Country:US
Mailing Address - Phone:818-326-9061
Mailing Address - Fax:
Practice Address - Street 1:12455 SAN FERNANDO RD APT 319
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-7756
Practice Address - Country:US
Practice Address - Phone:818-326-9061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 225400000X
CA693231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner