Healthcare Provider Details

I. General information

NPI: 1457830127
Provider Name (Legal Business Name): RAQUEL CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 S BROADWAY FL 1
LOS ANGELES CA
90037-2729
US

IV. Provider business mailing address

4601 S BROADWAY FL 1
LOS ANGELES CA
90037-2729
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-4445
  • Fax: 323-682-0632
Mailing address:
  • Phone: 323-234-4445
  • Fax: 323-682-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: