Provider Demographics
NPI:1083940241
Name:CORTEZ, SUSAN BETH (ICCE, CD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:ICCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19524 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-3249
Mailing Address - Country:US
Mailing Address - Phone:510-410-4211
Mailing Address - Fax:
Practice Address - Street 1:19524 EAGLE ST
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-3249
Practice Address - Country:US
Practice Address - Phone:510-410-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02438374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula