Provider Demographics
NPI:1659326007
Name:CORTEZ, JAYNE GALERA (DPM)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:GALERA
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:DPM
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 536
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0536
Mailing Address - Country:US
Mailing Address - Phone:714-520-8470
Mailing Address - Fax:714-520-8471
Practice Address - Street 1:555 N STATE COLLEGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2920
Practice Address - Country:US
Practice Address - Phone:714-520-8470
Practice Address - Fax:714-520-8471
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4524213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E4524Medicaid
CA000E4524Medicaid
V00219Medicare UPIN
CAE4524CMedicare ID - Type Unspecified