Provider Demographics
NPI:1912349481
Name:CORTEZ, MARIO TIMOTEO LEE NG (NP-C)
Entity Type:Individual
Prefix:MR
First Name:MARIO TIMOTEO
Middle Name:LEE NG
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2883 MILANO LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3273
Mailing Address - Country:US
Mailing Address - Phone:832-878-3489
Mailing Address - Fax:
Practice Address - Street 1:2883 MILANO LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3273
Practice Address - Country:US
Practice Address - Phone:832-878-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily