Provider Demographics
NPI:1629070081
Name:CORTES, JUDE JIX (DC)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:JIX
Last Name:CORTES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7441 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6004
Mailing Address - Country:US
Mailing Address - Phone:619-464-1600
Mailing Address - Fax:619-464-6546
Practice Address - Street 1:7441 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-6004
Practice Address - Country:US
Practice Address - Phone:619-464-1600
Practice Address - Fax:619-464-6546
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550166198OtherTAX ID NUMBER
CAY16764Medicare UPIN
CA550166198OtherTAX ID NUMBER
CA6189990001Medicare NSC