Healthcare Provider Details

I. General information

NPI: 1548647639
Provider Name (Legal Business Name): KATHERINE LYNN CORTEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/18/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 AREA MARINE CENTERED MEDICAL HOME BLDG 22190
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

220 HOVEY RD
PENSACOLA FL
32508-1044
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-3784
  • Fax:
Mailing address:
  • Phone: 850-452-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number29372
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: