Provider Demographics
NPI:1902100753
Name:CORTEZ, PATRICIA MARTINEZ (STNA #40099791109)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARTINEZ
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:STNA #40099791109
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:BARRIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3435 GROVE AVE.
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2050
Mailing Address - Country:US
Mailing Address - Phone:440-277-9757
Mailing Address - Fax:
Practice Address - Street 1:3435 GROVE AVE.
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2050
Practice Address - Country:US
Practice Address - Phone:440-277-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRH537028172A00000X
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172A00000XOther Service ProvidersDriver