Healthcare Provider Details

I. General information

NPI: 1912636556
Provider Name (Legal Business Name): CORTEZ NEUROSURGERY & NEUROVASCULAR SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 CAJON ST STE B
REDLANDS CA
92373-5982
US

IV. Provider business mailing address

508 CAJON ST STE B
REDLANDS CA
92373-5982
US

V. Phone/Fax

Practice location:
  • Phone: 909-283-4101
  • Fax: 909-283-4105
Mailing address:
  • Phone: 909-283-4101
  • Fax: 909-283-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VLADIMIR ADRIANO CORTEZ
Title or Position: NEUROSURGEON
Credential: DO
Phone: 909-809-2101