Provider Demographics
NPI:1659624690
Name:BEZERRA FILHO, JOSE RENATO CORTEZ
Entity Type:Individual
Prefix:
First Name:JOSE RENATO
Middle Name:CORTEZ
Last Name:BEZERRA FILHO
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 1:9116 CANOGA CANYON CT UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-2958
Mailing Address - Country:US
Mailing Address - Phone:641-954-2333
Mailing Address - Fax:
Practice Address - Street 1:9116 CANOGA CANYON CT UNIT 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2958
Practice Address - Country:US
Practice Address - Phone:641-954-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner