Provider Demographics
NPI:1447482229
Name:CORTEZ, LIDA (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 HIKERS TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1838
Mailing Address - Country:US
Mailing Address - Phone:619-917-8268
Mailing Address - Fax:
Practice Address - Street 1:1611 HIKERS TRAIL DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1838
Practice Address - Country:US
Practice Address - Phone:619-917-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist