Provider Demographics
NPI:1497081756
Name:CORTEZ, ESTEBAN DANIEL (PA)
Entity Type:Individual
Prefix:MR
First Name:ESTEBAN
Middle Name:DANIEL
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:PA
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 4624
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4624
Mailing Address - Country:US
Mailing Address - Phone:956-362-6683
Mailing Address - Fax:956-362-6818
Practice Address - Street 1:5540 RAPHAEL DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1407
Practice Address - Country:US
Practice Address - Phone:956-362-6683
Practice Address - Fax:956-362-6836
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06521363AS0400X, 363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX290353603Medicaid
TX290353603Medicaid