Basic Information
| Provider Information | |||||||||
| NPI: | 1952316648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORTIZO | ||||||||
| FirstName: | ROSITA | ||||||||
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| Credential: | MFT PSY D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12261 CARMEL VISTA RD UNIT 179 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921302534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582592664 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 VALPREDA RD | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920692973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607366780 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 12/01/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC37949 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103T00000X | 22278 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.