Provider Demographics
NPI:1932507506
Name:CORTES, KIMBERLY MEGHAN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MEGHAN
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 1:5225 CANYON CREST DR STE 400
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6361
Mailing Address - Country:US
Mailing Address - Phone:951-385-3993
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR STE 400
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6361
Practice Address - Country:US
Practice Address - Phone:951-385-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103594106H00000X
CA84028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist