Provider Demographics
NPI:1174238901
Name:CORTEZ, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8302 6TH AVE APT A12
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4505
Mailing Address - Country:US
Mailing Address - Phone:718-483-3408
Mailing Address - Fax:
Practice Address - Street 1:8302 6TH AVE APT A12
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4505
Practice Address - Country:US
Practice Address - Phone:718-483-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY728519163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency