Provider Demographics
NPI:1841016359
Name:GAJ, ALVONTE CORTEZ
Entity type:Individual
Prefix:MR
First Name:ALVONTE
Middle Name:CORTEZ
Last Name:GAJ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 BRAMLEY DR
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-1308
Mailing Address - Country:US
Mailing Address - Phone:330-593-9242
Mailing Address - Fax:
Practice Address - Street 1:6324 BRAMLEY DR
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-1308
Practice Address - Country:US
Practice Address - Phone:330-593-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health