Provider Demographics
NPI:1003193467
Name:CORTEZ, GABRIELA A (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:A
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1755
Mailing Address - Country:US
Mailing Address - Phone:773-318-6999
Mailing Address - Fax:
Practice Address - Street 1:4646 N MARINE DR STE C6100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-6025
Practice Address - Fax:773-564-6026
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000404363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical