Provider Demographics
NPI:1477190056
Name:CORTES, CECELIA
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
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 1:355 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSON
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1213
Mailing Address - Country:US
Mailing Address - Phone:570-267-3828
Mailing Address - Fax:
Practice Address - Street 1:355 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SIMPSON
Practice Address - State:PA
Practice Address - Zip Code:18407-1213
Practice Address - Country:US
Practice Address - Phone:570-267-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider