Healthcare Provider Details

I. General information

NPI: 1548462245
Provider Name (Legal Business Name): MISS ELSA IRIS CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LOS ANGELES CALLE LAS FLORES WD 22
CAROLINA PR
00983-3845
US

IV. Provider business mailing address

URB VILLA FONTANA VIA 31 4CN6
CAROLINA PR
00983-3845
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-5403
  • Fax: 787-253-3892
Mailing address:
  • Phone: 787-750-5403
  • Fax: 787-253-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number003033
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: