1457394637 NPI number — JOSEPH M. CORTEZ, D.P.M., INC

Table of content: (NPI 1457394637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457394637 NPI number — JOSEPH M. CORTEZ, D.P.M., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH M. CORTEZ, D.P.M., INC
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:
1457394637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2443 POCOMOKE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93065-5803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-522-9779
Provider Business Mailing Address Fax Number:
805-522-9779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21911 DEVONSHIRE ST
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
CHATSWORTH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91311-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-993-8675
Provider Business Practice Location Address Fax Number:
805-522-9779
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORTEZ
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
805-522-9779

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E3956 , 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: 000E39560 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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