Provider Demographics
NPI:1932608973
Name:CORTINAS, JOHNNY RAY
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:RAY
Last Name:CORTINAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2981
Mailing Address - Country:US
Mailing Address - Phone:510-465-4569
Mailing Address - Fax:833-516-1896
Practice Address - Street 1:425 VERNON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2981
Practice Address - Country:US
Practice Address - Phone:510-465-4569
Practice Address - Fax:833-516-1896
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator