Provider Demographics
NPI:1275768574
Name:CORTES, MARIA DELOURDES
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:DELOURDES
Last Name:CORTES
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 1:1010 W LA VETA AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4305
Mailing Address - Country:US
Mailing Address - Phone:714-746-9675
Mailing Address - Fax:
Practice Address - Street 1:1010 W LA VETA AVE STE 510
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4305
Practice Address - Country:US
Practice Address - Phone:714-746-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90-0459231OtherEIN