Healthcare Provider Details

I. General information

NPI: 1740984707
Provider Name (Legal Business Name): JACOB CORTEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE STE 750
ORANGE CA
92868-4312
US

IV. Provider business mailing address

1010 W LA VETA AVE STE 750
ORANGE CA
92868-4312
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A23360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: