Healthcare Provider Details

I. General information

NPI: 1255639449
Provider Name (Legal Business Name): GLORIA E CORTEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GIRARD ST 212 A
GAITHERSBURG MD
20877-3466
US

IV. Provider business mailing address

15850 CRABBS BRANCH WAY 350
ROCKVILLE MD
20855-2622
US

V. Phone/Fax

Practice location:
  • Phone: 301-216-0880
  • Fax: 301-216-2891
Mailing address:
  • Phone: 240-499-2636
  • Fax: 240-499-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR191692
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: