Provider Demographics
NPI:1780224022
Name:CORTINAS, DESI RAE
Entity type:Individual
Prefix:
First Name:DESI
Middle Name:RAE
Last Name:CORTINAS
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 1:17655 HENDERSON PASS APT 1528
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1561
Mailing Address - Country:US
Mailing Address - Phone:956-832-9222
Mailing Address - Fax:
Practice Address - Street 1:17655 HENDERSON PASS APT 1528
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1561
Practice Address - Country:US
Practice Address - Phone:956-832-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer