Provider Demographics
NPI:1003858994
Name:CORTES-SOTO, GREGORIO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:A
Last Name:CORTES-SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1644
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1644
Mailing Address - Country:US
Mailing Address - Phone:787-726-8396
Mailing Address - Fax:787-727-6672
Practice Address - Street 1:1826 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3004
Practice Address - Country:US
Practice Address - Phone:787-726-8396
Practice Address - Fax:787-727-6672
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE43430Medicare UPIN
PR29769Medicare ID - Type Unspecified