Provider Demographics
NPI:1962147454
Name:CORTEZ, LIBERTY BELLE
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:BELLE
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 1:3300 HIDEAWAY LN
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1660
Mailing Address - Country:US
Mailing Address - Phone:714-319-8378
Mailing Address - Fax:
Practice Address - Street 1:3300 HIDEAWAY LN
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1660
Practice Address - Country:US
Practice Address - Phone:714-319-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician