Provider Demographics
NPI:1871790212
Name:CORTES-STEFANOVIC, GRACE J (OD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:J
Last Name:CORTES-STEFANOVIC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:J
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3060 STABLE WAY
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-5109
Mailing Address - Country:US
Mailing Address - Phone:951-966-9189
Mailing Address - Fax:
Practice Address - Street 1:480 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1291
Practice Address - Country:US
Practice Address - Phone:951-279-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist