Provider Demographics
NPI:1730513771
Name:CORTES, JULISSA YVONNE (PSYD)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:YVONNE
Last Name:CORTES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 ROSELAWN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1149
Mailing Address - Country:US
Mailing Address - Phone:213-249-5468
Mailing Address - Fax:
Practice Address - Street 1:601 E GLENOAKS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1780
Practice Address - Country:US
Practice Address - Phone:310-375-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAPSY34400103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical