NPI | 1558846063 |
---|---|
Former Name | ALFREDO CORTEZ |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4485) |
363A00000X Physician Assistant | |
Enumeration Date | 2018-10-01 |
Last Update Date | 2024-06-19 |