Healthcare Provider Details

I. General information

NPI: 1467357517
Provider Name (Legal Business Name): CORTIS REP PUERTO RICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. PUGNADO AFUERA CARR. 670 KM 9.0
VEGA BAJA PR
00693-5422
US

IV. Provider business mailing address

ALT. DE VEGA BAJA D 1 STREET C
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-0966
  • Fax:
Mailing address:
  • Phone: 787-629-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULISHA L CORTES
Title or Position: CEO
Credential:
Phone: 787-629-0966