Healthcare Provider Details

I. General information

NPI: 1629904479
Provider Name (Legal Business Name): GABRIEL CORTEZ MPH , RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

302 COLUMBUS DR
ANN ARBOR MI
48103-2792
US

IV. Provider business mailing address

302 COLUMBUS DR
ANN ARBOR MI
48103-2792
US

V. Phone/Fax

Practice location:
  • Phone: 956-588-6044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86360141
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: