Healthcare Provider Details

I. General information

NPI: 1538316021
Provider Name (Legal Business Name): CORA D. CORTEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14373 HOLMWOOD DR
MAGALIA CA
95954-9323
US

IV. Provider business mailing address

14373 HOLMWOOD DR
MAGALIA CA
95954-9323
US

V. Phone/Fax

Practice location:
  • Phone: 530-216-6050
  • Fax:
Mailing address:
  • Phone: 530-216-6050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN156352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: