Provider Demographics
NPI:1649833104
Name:CORTICA BEHAVIORAL HEALTH INC.
Entity type:Organization
Organization Name:CORTICA BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIOR TECHNICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORNEST
Authorized Official - Middle Name:MILLANAR
Authorized Official - Last Name:PAMELAR
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:619-394-0777
Mailing Address - Street 1:7471 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6132
Mailing Address - Country:US
Mailing Address - Phone:619-394-0777
Mailing Address - Fax:
Practice Address - Street 1:7090 MIRATECH DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3109
Practice Address - Country:US
Practice Address - Phone:858-304-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty