Healthcare Provider Details

I. General information

NPI: 1063997211
Provider Name (Legal Business Name): ROSALIO CORTEZ JR. LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 W SHAW AVE STE 114
FRESNO CA
93711-3303
US

IV. Provider business mailing address

13571 AMIGO AVE
PARLIER CA
93648-2301
US

V. Phone/Fax

Practice location:
  • Phone: 559-374-3990
  • Fax:
Mailing address:
  • Phone: 559-859-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number698504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: