Provider Demographics
NPI:1982339503
Name:CORTEZ, YADIRA ABIGAIL
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:ABIGAIL
Last Name:CORTEZ
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 1:965 W 140TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3472
Mailing Address - Country:US
Mailing Address - Phone:805-766-3238
Mailing Address - Fax:
Practice Address - Street 1:965 W 140TH ST
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3472
Practice Address - Country:US
Practice Address - Phone:805-766-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist