Basic Information
| Provider Information | |||||||||
| NPI: | 1508530601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORTES ACOSTA | ||||||||
| FirstName: | SERGIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8243 RANCHVIEW DR APT 3090 | ||||||||
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| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750637688 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5200 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145908000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT86061 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.