Provider Demographics
NPI:1538838875
Name:JOHNSON, CORTEZ
Entity type:Individual
Prefix:
First Name:CORTEZ
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4752
Mailing Address - Country:US
Mailing Address - Phone:513-888-8251
Mailing Address - Fax:
Practice Address - Street 1:2300 MONTANA AVE UNIT 427
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-280-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide