Provider Demographics
NPI:1356768568
Name:CORTEZ, LAURA M (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:F
Other - Last Name:MENDIOLA-CORTEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 S BRYAN RD STE 209
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6659
Mailing Address - Country:US
Mailing Address - Phone:956-424-1511
Mailing Address - Fax:956-424-3575
Practice Address - Street 1:910 S BRYAN RD STE 209
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6659
Practice Address - Country:US
Practice Address - Phone:956-424-1511
Practice Address - Fax:956-424-3575
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX553309YLPSOtherWELLMED PTAN