Provider Demographics
NPI:1639801442
Name:CORTEZ, BAHARA
Entity Type:Individual
Prefix:
First Name:BAHARA
Middle Name:
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 1:9496 MAGNOLIA AVE STE 206A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3733
Mailing Address - Country:US
Mailing Address - Phone:951-313-4779
Mailing Address - Fax:
Practice Address - Street 1:9496 MAGNOLIA AVE STE 206A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3733
Practice Address - Country:US
Practice Address - Phone:951-313-4779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)