Healthcare Provider Details

I. General information

NPI: 1558765446
Provider Name (Legal Business Name): CORTES DERMATOLOGY & INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE SEVERIANO CUEVAS WESTERN MEDICAL PLAZA, SUITE 19
AGUADILLA PR
00603-0477
US

IV. Provider business mailing address

PO BOX 250477
AGUADILLA PR
00604-0477
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-6306
  • Fax: 787-658-6308
Mailing address:
  • Phone: 787-658-6306
  • Fax: 787-658-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18888
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18907
License Number StatePR

VIII. Authorized Official

Name: GIL Y CORTES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-658-6306