Provider Demographics
NPI:1366554156
Name:FERNANDEZ, LOURDES CORTES (X-RAY TECHNICIAN)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:CORTES
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:X-RAY TECHNICIAN
Other - Prefix:MISS
Other - First Name:LOURDES
Other - Middle Name:BULOS
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:209-937-0973
Mailing Address - Fax:209-937-0996
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:209-937-0973
Practice Address - Fax:209-937-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHP758272471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22677ZMedicare ID - Type Unspecified