Provider Demographics
NPI:1215034343
Name:PABLO G. CORTINA M.D., INC.
Entity Type:Organization
Organization Name:PABLO G. CORTINA M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:GARZA
Authorized Official - Last Name:CORTINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-468-8587
Mailing Address - Street 1:1101 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6341
Mailing Address - Country:US
Mailing Address - Phone:707-468-8787
Mailing Address - Fax:707-468-8725
Practice Address - Street 1:1101 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6341
Practice Address - Country:US
Practice Address - Phone:707-468-8787
Practice Address - Fax:707-468-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G475613Medicaid
CA00G475613Medicaid