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General NPI Number Information
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NPI Number | 1467357517
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Entity Type | Organization
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Legal Business Name | CORTIS REP PUERTO RICO LLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | BO. PUGNADO AFUERA CARR. 670 KM 9.0
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City | VEGA BAJA
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State | PR
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Zip | 00693-5422
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Country | US
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Telephone | 787-629-0966
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Fax |
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Provider Business Mailing Address
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Address Line | ALT. DE VEGA BAJA D 1 STREET C
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-629-0966
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JULISHA L CORTES
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Credential |
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Telephone | 787-629-0966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | NULL
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