Healthcare Provider Details

I. General information

NPI: 1982097085
Provider Name (Legal Business Name): MIRELLA CORTEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31845 TEMECULA PKWY STE 102
TEMECULA CA
92592-2871
US

IV. Provider business mailing address

2920 TELEGRAPH AVE STE 100
BERKELEY CA
94705-2031
US

V. Phone/Fax

Practice location:
  • Phone: 951-210-7368
  • Fax: 888-972-1912
Mailing address:
  • Phone: 415-549-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54211
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC005679
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: