Healthcare Provider Details

I. General information

NPI: 1164893947
Provider Name (Legal Business Name): DR. BRIAN CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 MAIN ST
LONGMONT CO
80501-1488
US

IV. Provider business mailing address

2255 MAIN ST
LONGMONT CO
80501-1488
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-7552
  • Fax:
Mailing address:
  • Phone: 303-772-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0021086
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: