Healthcare Provider Details

I. General information

NPI: 1427225390
Provider Name (Legal Business Name): JAMIME O CORTES MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 INTERNATIONAL BLVD SUITE 404
OAKLAND CA
94601-1537
US

IV. Provider business mailing address

2647 INTERNATIONAL BLVD SUITE 404
OAKLAND CA
94601-1537
US

V. Phone/Fax

Practice location:
  • Phone: 818-504-7265
  • Fax: 818-504-1623
Mailing address:
  • Phone: 818-504-7265
  • Fax: 818-504-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA63927
License Number StateCA

VIII. Authorized Official

Name: DR. JAIME O CORES
Title or Position: CEO
Credential: M.D.
Phone: 818-504-7265