Healthcare Provider Details

I. General information

NPI: 1417917139
Provider Name (Legal Business Name): ROSA A CORTES-RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND MADRID 1760 LOIZA STREET SUITE 206
SAN JUAN PR
00911-1801
US

IV. Provider business mailing address

26 CALLE WASHINGTON APT 11-B
SAN JUAN PR
00907-1513
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-5486
  • Fax: 787-728-6031
Mailing address:
  • Phone: 787-726-5486
  • Fax: 787-728-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number010794
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: