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NPI Code Detail

MEDICARE: CARLOS R CORTEZ-PACHECO DDS

MEDICARE:   CARLOS R CORTEZ-PACHECO  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry52845CA

General Provider Information

NPI Number : 1043435712
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS R CORTEZ-PACHECO DDS
Provider Business Mailing Address
First Line : 731 E VERDUGO AVE APT 101
Second Line :
City : BURBANK
State : CA
Zip : 91501-3118
Country : US
Telephone Number : 818-391-6999
Fax Number :
Provider Business Practice Location Address
First Line : 1330 S VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-4502
Country : US
Telephone Number : 213-383-7315
Fax Number : 213-383-3483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 09/24/2012

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Directions to “ CARLOS R CORTEZ-PACHECO DDS” Practice Location

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