=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255545034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALVADOR PABON CORTES M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2007
-----------------------------------------------------
Last Update Date | 02/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 GONZALEZ GUISTI AVE CAPARRA GALLERY BLDG SUITE 304
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-707-0020
-----------------------------------------------------
Fax | 787-782-2056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 AVE FELISA R DE GAUTIER APT 2109
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-6638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-707-0020
-----------------------------------------------------
Fax | 787-782-2056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 10905
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------