Healthcare Provider Details

I. General information

NPI: 1336414309
Provider Name (Legal Business Name): DANIEL CORTEZ MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

1844 W CULVER AVE APT 6
ORANGE CA
92868-4111
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-4572
  • Fax:
Mailing address:
  • Phone: 303-718-6871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License NumberA120134
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA120134
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number63794
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA120134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: