Provider Demographics
NPI:1720613045
Name:CORTEZ, JAVIER ANTONIO (PSYD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ANTONIO
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAIN PLZ
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2745
Mailing Address - Country:US
Mailing Address - Phone:210-222-2498
Mailing Address - Fax:
Practice Address - Street 1:311 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1979
Practice Address - Country:US
Practice Address - Phone:630-894-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009949103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical