Provider Demographics
NPI:1639400716
Name:CORTEZ, RANDY (MA, PHLEBOTOMY TEC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:MA, PHLEBOTOMY TEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-1349
Mailing Address - Country:US
Mailing Address - Phone:956-525-6997
Mailing Address - Fax:
Practice Address - Street 1:1806 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-4217
Practice Address - Country:US
Practice Address - Phone:956-525-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy