Provider Demographics
NPI:1083212534
Name:CORTES VERA, KEISHLA MARIE
Entity Type:Individual
Prefix:
First Name:KEISHLA
Middle Name:MARIE
Last Name:CORTES VERA
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 1:7400 SAN PEDRO DR NE APT 1015
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4688
Mailing Address - Country:US
Mailing Address - Phone:939-225-0655
Mailing Address - Fax:
Practice Address - Street 1:7400 SAN PEDRO DR NE APT 1015
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4688
Practice Address - Country:US
Practice Address - Phone:939-225-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00009325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist