Provider Demographics
NPI:1003903626
Name:CORTINA, PABLO GARZA (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:GARZA
Last Name:CORTINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6341
Mailing Address - Country:US
Mailing Address - Phone:707-468-8587
Mailing Address - Fax:707-468-8725
Practice Address - Street 1:1101 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6341
Practice Address - Country:US
Practice Address - Phone:707-468-8587
Practice Address - Fax:707-468-8725
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47561207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G475613Medicaid
CA00G475613Medicaid