Provider Demographics
NPI:1689055162
Name:CORTES, PAULO (DMD)
Entity type:Individual
Prefix:
First Name:PAULO
Middle Name:
Last Name:CORTES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10737 CAMINO RUIZ STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2361
Mailing Address - Country:US
Mailing Address - Phone:619-788-8278
Mailing Address - Fax:
Practice Address - Street 1:10737 CAMINO RUIZ STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2361
Practice Address - Country:US
Practice Address - Phone:858-566-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice