Provider Demographics
NPI:1669862454
Name:CORTEZ, BRANDON JON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JON
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:435 LA VACA DR S
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4181
Mailing Address - Country:US
Mailing Address - Phone:361-549-6834
Mailing Address - Fax:
Practice Address - Street 1:1734 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1857
Practice Address - Country:US
Practice Address - Phone:361-883-6211
Practice Address - Fax:361-882-4891
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP127370367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered