Provider Demographics
NPI:1396190443
Name:YOLANDA E. CORTEZ DDS INS
Entity Type:Organization
Organization Name:YOLANDA E. CORTEZ DDS INS
Other - Org Name:INTERNATIONAL DENTAL ESTUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-761-7109
Mailing Address - Street 1:5451 LAUREL CANYON BLVD
Mailing Address - Street 2:102
Mailing Address - City:VALLEY VILLEGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-761-7109
Mailing Address - Fax:
Practice Address - Street 1:5451 LAUREL CANYON BLVD
Practice Address - Street 2:102
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2180
Practice Address - Country:US
Practice Address - Phone:818-761-7109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56546OtherDENTIST