Healthcare Provider Details

I. General information

NPI: 1760343651
Provider Name (Legal Business Name): CORTEZ RAFEL FABIA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 YOUNG ST APT 402
HONOLULU HI
96814-1930
US

IV. Provider business mailing address

1125 YOUNG ST APT 402
HONOLULU HI
96814-1930
US

V. Phone/Fax

Practice location:
  • Phone: 817-915-7628
  • Fax:
Mailing address:
  • Phone: 817-915-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-5583
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: