Provider Demographics
NPI:1104454073
Name:CORTEZ, SUSANA GUADALUPE
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:GUADALUPE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17130 DEVONSHIRE ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1676
Mailing Address - Country:US
Mailing Address - Phone:747-300-2191
Mailing Address - Fax:
Practice Address - Street 1:17130 DEVONSHIRE ST STE 104A
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1676
Practice Address - Country:US
Practice Address - Phone:747-300-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator