Provider Demographics
NPI:1952972184
Name:CORTES, ANGELIC BURGUNDI (CPT)
Entity Type:Individual
Prefix:
First Name:ANGELIC
Middle Name:BURGUNDI
Last Name:CORTES
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9664
Mailing Address - Country:US
Mailing Address - Phone:442-340-4706
Mailing Address - Fax:
Practice Address - Street 1:1621 VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9664
Practice Address - Country:US
Practice Address - Phone:442-340-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-02016349246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy