Provider Demographics
NPI:1043558927
Name:CORTEZ, NICOLE
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:CORTEZ
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 1:6536 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:CA
Mailing Address - Zip Code:95388-9672
Mailing Address - Country:US
Mailing Address - Phone:209-761-2932
Mailing Address - Fax:
Practice Address - Street 1:6536 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:CA
Practice Address - Zip Code:95388-9672
Practice Address - Country:US
Practice Address - Phone:209-761-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information