Healthcare Provider Details

I. General information

NPI: 1376753012
Provider Name (Legal Business Name): EVELYN CORTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. 1 COLINAS DE LUQUILLO NO. 43
LUQUILLO PR
00773
US

IV. Provider business mailing address

PO BOX 971
LUQUILLO PR
00773-0971
US

V. Phone/Fax

Practice location:
  • Phone: 787-245-7744
  • Fax: 787-355-9776
Mailing address:
  • Phone: 787-245-7744
  • Fax: 787-355-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11491
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: