Provider Demographics
NPI:1164047676
Name:CORTEZ, JESSICA (CPHT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 N CESAR CHAVEZ RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-6830
Mailing Address - Country:US
Mailing Address - Phone:956-310-1649
Mailing Address - Fax:
Practice Address - Street 1:1310 N TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-4210
Practice Address - Country:US
Practice Address - Phone:956-968-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy