Healthcare Provider Details

I. General information

NPI: 1821315813
Provider Name (Legal Business Name): BROOKE DOEGEY CORTEZ MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14314 DUSKY THRUSH
SAN ANTONIO TX
78233-5383
US

IV. Provider business mailing address

14314 DUSKY THRUSH
SAN ANTONIO TX
78233-5383
US

V. Phone/Fax

Practice location:
  • Phone: 210-995-6918
  • Fax:
Mailing address:
  • Phone: 210-995-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number06122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: