MEDICARE: MR. VINCENT FRANK CORTESE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHY22833	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0527979	OTHER		NABP
2	PH0A66040	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1497757140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT FRANK CORTESE

Provider Business Mailing Address
First Line	:	862 SAN PABLO AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1603
Country	:	US
Telephone Number	:	510-525-4811
Fax Number	:	510-525-4842

Provider Business Practice Location Address
First Line	:	862 SAN PABLO AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1603
Country	:	US
Telephone Number	:	510-525-4811
Fax Number	:	510-525-4842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/08/2007

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