Healthcare Provider Details

I. General information

NPI: 1609634591
Provider Name (Legal Business Name): KATHRYN R CORTES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 S BROADWAY
LOS ANGELES CA
90003-2033
US

IV. Provider business mailing address

7409 S BROADWAY
LOS ANGELES CA
90003-2033
US

V. Phone/Fax

Practice location:
  • Phone: 213-674-2436
  • Fax:
Mailing address:
  • Phone: 213-674-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF95029550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: