Provider Demographics
NPI:1548647639
Name:CORTEZ, KATHERINE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNN
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:220 HOVEY RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1044
Mailing Address - Country:US
Mailing Address - Phone:850-452-8494
Mailing Address - Fax:
Practice Address - Street 1:22 AREA MARINE CENTERED MEDICAL HOME
Practice Address - Street 2:BLDG 22190
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE293722083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN