Healthcare Provider Details

I. General information

NPI: 1376451062
Provider Name (Legal Business Name): HERNAN CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 HAMILTON DR
WEST DUNDEE IL
60118-3500
US

IV. Provider business mailing address

340 ANN ST APT 5
SOUTH ELGIN IL
60177-2164
US

V. Phone/Fax

Practice location:
  • Phone: 224-762-7699
  • Fax:
Mailing address:
  • Phone: 224-762-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: