Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | AZ |
NPI | 1043347586 |
---|---|
Provider Name | Nicole Renee Cortez |
First Address | Phoenix, AZ 85016-7461 |
Second Address | Phoenix, AZ 85006-2430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
174396 | (05) | AZ |