1427225390 NPI number — JAMIME O CORTES MD

Table of content: (NPI 1427225390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427225390 NPI number — JAMIME O CORTES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMIME O CORTES MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427225390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2647 INTERNATIONAL BLVD
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-504-7265
Provider Business Mailing Address Fax Number:
818-504-1623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2647 INTERNATIONAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-504-7265
Provider Business Practice Location Address Fax Number:
818-504-1623
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CORES
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
O
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
818-504-7265

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A63927 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A639270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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