Provider Demographics
NPI:1295348787
Name:CORTEZ, EMMA GUADALUPE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:GUADALUPE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HOPI HEALTH CARE
Mailing Address - Street 2:HWY 264 MP 388
Mailing Address - City:POLACCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86042
Mailing Address - Country:US
Mailing Address - Phone:928-737-6000
Mailing Address - Fax:928-737-6005
Practice Address - Street 1:HOPI HEALTH CARE
Practice Address - Street 2:HWY 264 MP 388
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6000
Practice Address - Fax:928-737-6005
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020529Medicaid