Provider Demographics
NPI:1790651552
Name:CORTEZ, MIRANDA JACQUELINE
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JACQUELINE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7573
Mailing Address - Country:US
Mailing Address - Phone:510-414-5327
Mailing Address - Fax:
Practice Address - Street 1:2441 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7573
Practice Address - Country:US
Practice Address - Phone:510-414-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist