Healthcare Provider Details

I. General information

NPI: 1760794895
Provider Name (Legal Business Name): VANESSA CORTES DE JORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 COLUMBIA ST STE 400
SEATTLE WA
98104-2053
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2090
  • Fax: 206-215-3099
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberMD60715630
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60715630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: