Healthcare Provider Details

I. General information

NPI: 1992465942
Provider Name (Legal Business Name): JESSICA CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 RANCHO VISTA BLVD
PALMDALE CA
93551-4822
US

IV. Provider business mailing address

3105 RANCHO VISTA BLVD
PALMDALE CA
93551-4822
US

V. Phone/Fax

Practice location:
  • Phone: 661-538-1601
  • Fax: 661-538-1367
Mailing address:
  • Phone: 661-538-1601
  • Fax: 661-538-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: