Healthcare Provider Details

I. General information

NPI: 1578287785
Provider Name (Legal Business Name): RAFAEL EVERARDO CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 EMILY WAY APT C
MADERA CA
93637-5739
US

IV. Provider business mailing address

7339 N 1ST ST STE 105&110
FRESNO CA
93720-2954
US

V. Phone/Fax

Practice location:
  • Phone: 559-232-8716
  • Fax:
Mailing address:
  • Phone: 916-740-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: