Healthcare Provider Details

I. General information

NPI: 1225081680
Provider Name (Legal Business Name): RICHARD CORTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 AVE ESMERALDA
GUAYNABO PR
00969-4429
US

IV. Provider business mailing address

COND LAGOON FLTS AVE. WILSON 1081
SAN JUAN PR
00907-1870
US

V. Phone/Fax

Practice location:
  • Phone: 787-790-7393
  • Fax:
Mailing address:
  • Phone: 787-722-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9519
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: