Healthcare Provider Details

I. General information

NPI: 1790443729
Provider Name (Legal Business Name): JOSE ANTONIO CORTES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CALLE NUEVO LONDRES
UTUADO PR
00641-2719
US

IV. Provider business mailing address

PO BOX 1836
UTUADO PR
00641-1836
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-8492
  • Fax:
Mailing address:
  • Phone: 786-657-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22905
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: