Healthcare Provider Details

I. General information

NPI: 1174238901
Provider Name (Legal Business Name): DAVID CORTEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 6TH AVE APT A12
BROOKLYN NY
11209-4505
US

IV. Provider business mailing address

8302 6TH AVE APT A12
BROOKLYN NY
11209-4505
US

V. Phone/Fax

Practice location:
  • Phone: 718-483-3408
  • Fax:
Mailing address:
  • Phone: 718-483-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number728519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: