Provider Demographics
NPI:1093954034
Name:CORTEZ, KIMBERLY DAWN (AESTHETICIAN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:AESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5738 TIMBERHURST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4177
Mailing Address - Country:US
Mailing Address - Phone:210-461-0477
Mailing Address - Fax:210-680-9440
Practice Address - Street 1:14855 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7732
Practice Address - Country:US
Practice Address - Phone:210-461-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001188028246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other