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General NPI Number Information
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NPI Number | 1467644336
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Entity Type | Organization
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Legal Business Name | LUIS R CORTES DO PA
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 255 SE 14TH ST SUITE 1C
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1852
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Country | US
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Telephone | 954-358-9900
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Fax | 954-358-9901
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Provider Business Mailing Address
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Address Line | 255 SE 14TH ST SUITE 1C
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1852
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Country | US
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Telephone | 954-358-9900
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Fax | 954-358-9901
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS RICARDO CORTES
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Credential | D.O.
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Telephone | 954-358-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS9656
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License Number State | FL
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