Provider Demographics
NPI:1467814681
Name:CORTINA, EMMANUEL ADAN
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ADAN
Last Name:CORTINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 RODRIGUEZ
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-7971
Mailing Address - Country:US
Mailing Address - Phone:956-568-5033
Mailing Address - Fax:
Practice Address - Street 1:457 RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-7971
Practice Address - Country:US
Practice Address - Phone:956-568-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345549962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer