Provider Demographics
NPI:1598900979
Name:CORTEZ, CARLOS ANTONIO MEJIA
Entity Type:Individual
Prefix:
First Name:CARLOS ANTONIO
Middle Name:MEJIA
Last Name:CORTEZ
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 1:13716 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2626
Mailing Address - Country:US
Mailing Address - Phone:818-988-2020
Mailing Address - Fax:818-988-2004
Practice Address - Street 1:13716 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2626
Practice Address - Country:US
Practice Address - Phone:818-988-2020
Practice Address - Fax:818-988-2004
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant