Healthcare Provider Details

I. General information

NPI: 1659400612
Provider Name (Legal Business Name): SANDY E CORTEZ RD CFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 YGNACIO VALLEY RD STE 201
WALNUT CREEK CA
94598-3125
US

IV. Provider business mailing address

1776 YGNACIO VALLEY RD STE 201
WALNUT CREEK CA
94598-3125
US

V. Phone/Fax

Practice location:
  • Phone: 925-305-1919
  • Fax: 925-407-2838
Mailing address:
  • Phone: 925-305-1919
  • Fax: 925-407-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number0958881
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: