Healthcare Provider Details

I. General information

NPI: 1205027901
Provider Name (Legal Business Name): JAVIER A CORTES HMC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 COVE RD BLDG 3853
VIRGINIA BEACH VA
23459-8910
US

IV. Provider business mailing address

1355 HELICOPTER RD BLDG 3812
VIRGINIA BEACH VA
23459-8937
US

V. Phone/Fax

Practice location:
  • Phone: 757-763-3788
  • Fax:
Mailing address:
  • Phone: 757-763-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: