Provider Demographics
NPI:1154340958
Name:CORTEZ, RICARDO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name: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 1:1801 S 5TH ST STE 122
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2915
Mailing Address - Country:US
Mailing Address - Phone:956-762-5500
Mailing Address - Fax:956-229-6191
Practice Address - Street 1:1801 S 5TH ST STE 122
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2915
Practice Address - Country:US
Practice Address - Phone:956-762-5500
Practice Address - Fax:956-229-6191
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN-8000207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329394603Medicaid