Basic Information
| Provider Information | |||||||||
| NPI: | 1164436408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORTEZ | ||||||||
| FirstName: | ERNESTO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 REMITTANCE DRIVE DEPT 6008 | ||||||||
| Address2: | PIONEER MEDICAL GROUP INC | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606756008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622821419 | ||||||||
| FaxNumber: | 5629204642 | ||||||||
| Practice Location | |||||||||
| Address1: | 10251 ARTESIA BLVD | ||||||||
| Address2: | |||||||||
| City: | BELLFLOWER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907066719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628678681 | ||||||||
| FaxNumber: | 5629252721 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A6055 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 6055 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080179413 | 01 | CA | RAILROAD MEDICARE | OTHER | 020A60550 | 01 | CA | BLUE SHIELD | OTHER | 080179413 | 01 | CA | MEDICARE RAILROAD | OTHER | 00AX60550 | 05 | CA | MEDICAID |