MEDICARE: YOLANDA E. CORTEZ DDS INS

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
1	122300000X	Dentist	56546	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56546	OTHER	CA	DENTIST

General Provider Information

NPI Number	:	1396190443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOLANDA E. CORTEZ DDS INS

Provider Business Mailing Address
First Line	:	5451 LAUREL CANYON BLVD
Second Line	:	102
City	:	VALLEY VILLEGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-761-7109
Fax Number	:

Provider Business Practice Location Address
First Line	:	5451 LAUREL CANYON BLVD
Second Line	:	102
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2180
Country	:	US
Telephone Number	:	818-761-7109
Fax Number	:

Authorized Official
Title or Position	:	DENTIST PROVIDER
Name	:	DR. YOLANDA E CORTEZ
Credential	:	DDS
Telephone Number	:	818-761-7109

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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