Provider Demographics
NPI:1184362360
Name:CORTINA, SOPHIA GABRIELLA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:GABRIELLA
Last Name:CORTINA
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 1:1304 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3202
Mailing Address - Country:US
Mailing Address - Phone:805-941-3856
Mailing Address - Fax:
Practice Address - Street 1:1304 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3202
Practice Address - Country:US
Practice Address - Phone:805-941-3856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician