Provider Demographics
NPI:1760366512
Name:CORTES HERRERA, EVELYN LIZETTE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:LIZETTE
Last Name:CORTES HERRERA
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 1:14183 SAINT TROPEZ CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2910
Mailing Address - Country:US
Mailing Address - Phone:909-665-5763
Mailing Address - Fax:
Practice Address - Street 1:14183 SAINT TROPEZ CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2910
Practice Address - Country:US
Practice Address - Phone:909-665-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician