Provider Demographics
NPI:1801323332
Name:CORTEZ-GOMEZ, BRENDA OFELIA (PHD)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:OFELIA
Last Name:CORTEZ-GOMEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 CHIMNEY FLATS LN
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1532
Mailing Address - Country:US
Mailing Address - Phone:619-994-1721
Mailing Address - Fax:
Practice Address - Street 1:1730 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7625
Practice Address - Country:US
Practice Address - Phone:619-474-6703
Practice Address - Fax:619-477-0211
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist