1366554156 NPI number — MRS. LOURDES CORTES FERNANDEZ X-RAY TECHNICIAN

Table of content: MRS. LOURDES CORTES FERNANDEZ X-RAY TECHNICIAN (NPI 1366554156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366554156 NPI number — MRS. LOURDES CORTES FERNANDEZ X-RAY TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
LOURDES
Provider Middle Name:
CORTES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
X-RAY TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORTES
Provider Other First Name:
LOURDES
Provider Other Middle Name:
BULOS
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366554156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 N CALIFORNIA ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95204-6037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-937-0973
Provider Business Mailing Address Fax Number:
209-937-0996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 N CALIFORNIA ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95204-6037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-937-0973
Provider Business Practice Location Address Fax Number:
209-937-0996
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2471B0102X , with the licence number:  RHP75827 , 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)





Copyright © 2007-2025 www.npivalidator.com