Healthcare Provider Details

I. General information

NPI: 1295326098
Provider Name (Legal Business Name): JULIO CORTEZ RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 BRIARCREST DR STE 300
BRYAN TX
77802-2777
US

IV. Provider business mailing address

PO BOX 258831
OKLAHOMA CITY OK
73125-8831
US

V. Phone/Fax

Practice location:
  • Phone: 979-429-3785
  • Fax:
Mailing address:
  • Phone: 720-961-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21150653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: