MEDICARE: REZ LIWAG CORTEZ

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	163W00000X	Registered Nurse	742982	NY

General Provider Information

NPI Number	:	1902515216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REZ LIWAG CORTEZ

Provider Business Mailing Address
First Line	:	PO BOX 869
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-0869
Country	:	US
Telephone Number	:	619-499-3562
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 WEST, HIGHWAY 264
Second Line	:
City	:	SAINT MICHAELS
State	:	AZ
Zip	:	86511-8651
Country	:	US
Telephone Number	:	619-499-3562
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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Directions to “ REZ LIWAG CORTEZ ” Practice Location

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