Basic Information
| Provider Information | |||||||||
| NPI: | 1467954032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORTES | ||||||||
| FirstName: | AURORA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N PERRIS BLVD BLDG A | ||||||||
| Address2: | |||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925712811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514355391 | ||||||||
| FaxNumber: | 9514365352 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N PERRIS BLVD BLDG A | ||||||||
| Address2: | |||||||||
| City: | PERRIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925712811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9514365381 | ||||||||
| FaxNumber: | 9514365352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.