Provider Demographics
NPI:1043927569
Name:CORTEZ, JOVELINE CASTADA (CEO/OWNER)
Entity type:Individual
Prefix:
First Name:JOVELINE
Middle Name:CASTADA
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:CEO/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 GOLDFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3450
Mailing Address - Country:US
Mailing Address - Phone:971-601-2539
Mailing Address - Fax:
Practice Address - Street 1:1445 GOLDFIELD LN
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3450
Practice Address - Country:US
Practice Address - Phone:971-601-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty