Healthcare Provider Details

I. General information

NPI: 1881574879
Provider Name (Legal Business Name): ISSAC J CORTINAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 POLK ST FL 4
SAN FRANCISCO CA
94109-7813
US

IV. Provider business mailing address

106 N 31ST ST
SAN JOSE CA
95116-1203
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA97469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: