Provider Demographics
NPI:1497757140
Name:CORTESE, VINCENT FRANK
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:FRANK
Last Name:CORTESE
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 1:862 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1603
Mailing Address - Country:US
Mailing Address - Phone:510-525-4811
Mailing Address - Fax:510-525-4842
Practice Address - Street 1:862 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1603
Practice Address - Country:US
Practice Address - Phone:510-525-4811
Practice Address - Fax:510-525-4842
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY22833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0527979OtherNABP
CAPH0A66040OtherMEDICAL