Provider Demographics
NPI:1073835484
Name:CORTES, NOEMI
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CALLE CONCEPCION VERA
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-5016
Mailing Address - Country:US
Mailing Address - Phone:787-636-9577
Mailing Address - Fax:787-877-4454
Practice Address - Street 1:815 CALLE CONCEPCION VERA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-5016
Practice Address - Country:US
Practice Address - Phone:787-636-9577
Practice Address - Fax:787-877-4454
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR48771835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0923195OtherBIRTHDAY