Healthcare Provider Details

I. General information

NPI: 1982808028
Provider Name (Legal Business Name): IDALIA GARCIA CORTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 852 KM 0 HM 8 BO. DOS BOCAS
TRUJILLO ALTO PR
00976
US

IV. Provider business mailing address

PO BOX 218
TRUJILLO ALTO PR
00977-0218
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-0080
  • Fax:
Mailing address:
  • Phone: 787-638-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberDM10647-6
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDM10647-6
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: