Provider Demographics
NPI:1558846063
Name:CORTEZ MELENDEZ, ALFREDO CORTEZ (MS MPA PAC)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:CORTEZ
Last Name:CORTEZ MELENDEZ
Suffix:
Gender:M
Credentials:MS MPA PAC
Other - Prefix:
Other - First Name:ALFREDO
Other - Middle Name:
Other - Last Name:CORTEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10 YAKAMA WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5399
Mailing Address - Country:US
Mailing Address - Phone:415-378-5206
Mailing Address - Fax:
Practice Address - Street 1:10 YAKAMA WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5399
Practice Address - Country:US
Practice Address - Phone:415-378-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4485363A00000X
CA363A00000X
SC261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant