Provider Demographics
NPI:1649762881
Name:CORTEZ MEDINA, JORGE ALBERTO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALBERTO
Last Name:CORTEZ MEDINA
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:PO BOX 10947
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0947
Mailing Address - Country:US
Mailing Address - Phone:714-317-5603
Mailing Address - Fax:
Practice Address - Street 1:1615 E 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8529
Practice Address - Country:US
Practice Address - Phone:714-328-3728
Practice Address - Fax:714-541-7924
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker