Provider Demographics
NPI:1477801207
Name:BEGAYE, CORTASHA RAE (BS)
Entity Type:Individual
Prefix:
First Name:CORTASHA
Middle Name:RAE
Last Name:BEGAYE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0057
Mailing Address - Country:US
Mailing Address - Phone:928-814-4012
Mailing Address - Fax:
Practice Address - Street 1:5 MILES N OF FT DEFIANCE JCT RT 12 MILE MARKER 34
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-814-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD01342573343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)