Provider Demographics
NPI:1891200184
Name:RASSO-CORTEZ, JEREMY ADAM
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ADAM
Last Name:RASSO-CORTEZ
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 1:5880 LOCHMOOR DR APT 51
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8511
Mailing Address - Country:US
Mailing Address - Phone:951-567-9466
Mailing Address - Fax:
Practice Address - Street 1:17750 LASSELLE ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-6300
Practice Address - Country:US
Practice Address - Phone:951-485-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer