Provider Demographics
NPI:1912251059
Name:CORTEZ, MITSUKO ISHIMARU (ND, LAC)
Entity Type:Individual
Prefix:
First Name:MITSUKO
Middle Name:ISHIMARU
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 DEWING AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4246
Mailing Address - Country:US
Mailing Address - Phone:925-283-3860
Mailing Address - Fax:
Practice Address - Street 1:936 DEWING AVE STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4246
Practice Address - Country:US
Practice Address - Phone:925-283-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15027171100000X
CAND-545175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist