Healthcare Provider Details

I. General information

NPI: 1689052136
Provider Name (Legal Business Name): ROBERTO CORTEZ III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 06/22/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 210-286-7986
  • Fax:
Mailing address:
  • Phone: 210-286-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP03415
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: