Provider Demographics
NPI:1285462713
Name:CORTEZ, GABRIEL (LMT)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S CLOVER DR STE 5
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-8758
Mailing Address - Country:US
Mailing Address - Phone:970-884-9779
Mailing Address - Fax:
Practice Address - Street 1:175 S CLOVER DR STE 5
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-8758
Practice Address - Country:US
Practice Address - Phone:970-884-9779
Practice Address - Fax:970-884-0847
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0026463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist