Provider Demographics
NPI:1033239645
Name:CORTES, TANIA KEHAULANI IX (LMT)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:KEHAULANI
Last Name:CORTES
Suffix:IX
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 LEKEONA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3733
Mailing Address - Country:US
Mailing Address - Phone:808-721-7130
Mailing Address - Fax:808-312-1960
Practice Address - Street 1:1335 LEKEONA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3733
Practice Address - Country:US
Practice Address - Phone:808-721-7130
Practice Address - Fax:808-312-1960
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4493225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner