MEDICARE: IVAN JOSE CORTES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9935	PR
2	207V00000X	Obstetrics & Gynecology Physician	9935	PR

General Provider Information

NPI Number	:	1366507006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN JOSE CORTES MD

Provider Business Mailing Address
First Line	:	38 CALLE CAPRI
Second Line	:	PASEO LAS BRISAS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5947
Country	:	US
Telephone Number	:	787-748-0046
Fax Number	:	787-287-2273

Provider Business Practice Location Address
First Line	:	44 CALLE CARAZO
Second Line	:	OFFICE 2B
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5603
Country	:	US
Telephone Number	:	787-287-6545
Fax Number	:	787-287-2273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	10/14/2015

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