Provider Demographics
NPI:1295812493
Name:CORTEZ, CHRISTINE MARGARET (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARGARET
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:WASTAFERRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:2212 E 4TH STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3204
Mailing Address - Country:US
Mailing Address - Phone:714-628-3242
Mailing Address - Fax:714-744-0136
Practice Address - Street 1:2501 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3204
Practice Address - Country:US
Practice Address - Phone:714-628-3242
Practice Address - Fax:714-744-0136
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA968691133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered