Basic Information
Provider Information
NPI: 1811202013
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CORTEZ
FirstName: CHRISTINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LVN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 760 MOUNTAIN VIEW ST
Address2:  
City: ALTADENA
State: CA
PostalCode: 910014925
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 760 MOUNTAIN VIEW ST
Address2:  
City: ALTADENA
State: CA
PostalCode: 910014925
CountryCode: US
TelephoneNumber: 6267986793
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/11/2010
LastUpdateDate: 08/11/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164X00000XVN233751CAY Nursing Service ProvidersLicensed Vocational Nurse 

No ID Information.


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