Healthcare Provider Details

I. General information

NPI: 1588398804
Provider Name (Legal Business Name): GERRI NADINE CORTEZ-AHART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 N MARKS AVE # 110
FRESNO CA
93711-0268
US

IV. Provider business mailing address

7120 N MARKS AVE # 110
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: