Provider Demographics
NPI:1578346193
Name:CORTEZ, BREANA NICOLE
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:NICOLE
Last Name:CORTEZ
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 1:26252 PAPAGAYO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4124
Mailing Address - Country:US
Mailing Address - Phone:323-519-9357
Mailing Address - Fax:
Practice Address - Street 1:26252 PAPAGAYO DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4124
Practice Address - Country:US
Practice Address - Phone:323-519-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program