MEDICARE: MR. RANDY CORTEZ M.A., PHLEBOTOMY TEC

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	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1639400716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY CORTEZ M.A., PHLEBOTOMY TEC

Provider Business Mailing Address
First Line	:	PO BOX 1349
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-1349
Country	:	US
Telephone Number	:	956-525-6997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1806 ILLINOIS AVE
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4217
Country	:	US
Telephone Number	:	956-525-6997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2010
Last Update Date	:	01/29/2010

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