Basic Information
| Provider Information | |||||||||
| NPI: | 1477098747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORTES | ||||||||
| FirstName: | YOLANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2409 OCEANVIEW TER | ||||||||
| Address2: | |||||||||
| City: | SAN PEDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907316398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4247775017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 923 S CATALINA AVE | ||||||||
| Address2: | |||||||||
| City: | REDONDO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4247775017 | ||||||||
| FaxNumber: | 3107925463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2016 | ||||||||
| LastUpdateDate: | 04/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.