Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003442526 |
---|---|
Provider Name | Melinda Cortez |
First Address | Victorville, CA 92395-3209 |
Second Address | Victorville, CA 92395-3209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2020 |
Last Update Date | 16/03/2020 |