Provider Demographics
NPI:1205594561
Name:CORTES, ALEJANDRO SR
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:CORTES
Suffix:SR
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 1:3184 ENCHANTED CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-3407
Mailing Address - Country:US
Mailing Address - Phone:920-815-9102
Mailing Address - Fax:
Practice Address - Street 1:3184 ENCHANTED CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-3407
Practice Address - Country:US
Practice Address - Phone:920-815-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)