Provider Demographics
NPI:1598138273
Name:CORTEZ, JEAN-PAUL CARRILLO (NP)
Entity Type:Individual
Prefix:
First Name:JEAN-PAUL
Middle Name:CARRILLO
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26360 DODGE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3054
Mailing Address - Country:US
Mailing Address - Phone:650-534-8042
Mailing Address - Fax:
Practice Address - Street 1:26360 DODGE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-3054
Practice Address - Country:US
Practice Address - Phone:650-534-8042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014669363LP0808X
CAD8582941390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program