Provider Demographics
NPI:1932211109
Name:TORTOSA, MICHAEL (MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TORTOSA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 VIA PALO VERDE LAGO
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3218
Mailing Address - Country:US
Mailing Address - Phone:619-962-6748
Mailing Address - Fax:619-588-9747
Practice Address - Street 1:615 E LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4617
Practice Address - Country:US
Practice Address - Phone:619-962-6748
Practice Address - Fax:619-588-9747
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist