Healthcare Provider Details

I. General information

NPI: 1790488021
Provider Name (Legal Business Name): CARLOTA CORTEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1187 N WILLOW AVE # 103-835
CLOVIS CA
93611-4411
US

IV. Provider business mailing address

1187 N WILLOW AVE # 103-835
CLOVIS CA
93611-4411
US

V. Phone/Fax

Practice location:
  • Phone: 720-556-8915
  • Fax:
Mailing address:
  • Phone: 720-556-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: