Provider Demographics
NPI:1033168877
Name:CORTEZ, JOSEPH MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 E LOS ANGELES AVE
Mailing Address - Street 2:SUITE C308
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2868
Mailing Address - Country:US
Mailing Address - Phone:805-522-9779
Mailing Address - Fax:866-528-1083
Practice Address - Street 1:2443 POCOMOKE CT
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5803
Practice Address - Country:US
Practice Address - Phone:805-522-9779
Practice Address - Fax:866-528-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3956213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39560Medicaid
CAE3956Medicare ID - Type Unspecified
CA000E39560Medicaid