Healthcare Provider Details

I. General information

NPI: 1588371058
Provider Name (Legal Business Name): JOSE MANUEL CORTES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN BERNARDINO RD STE 103
UPLAND CA
91786-4985
US

IV. Provider business mailing address

19321 ADDIS ST
ROWLAND HEIGHTS CA
91748-2326
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-0444
  • Fax:
Mailing address:
  • Phone: 714-492-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: