Provider Demographics
NPI:1841076163
Name:CORTES, MARIA GUADALUPE JESSICA
Entity type:Individual
Prefix:
First Name:MARIA GUADALUPE
Middle Name:JESSICA
Last Name:CORTES
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 1:2643 S BASCOM AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5638
Mailing Address - Country:US
Mailing Address - Phone:669-302-4766
Mailing Address - Fax:
Practice Address - Street 1:2643 S BASCOM AVE APT 26
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-5638
Practice Address - Country:US
Practice Address - Phone:669-302-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist