Provider Demographics
NPI:1164115663
Name:CORTES, BENITO
Entity Type:Individual
Prefix:
First Name:BENITO
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:PO BOX 144036
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-4036
Mailing Address - Country:US
Mailing Address - Phone:787-420-7621
Mailing Address - Fax:787-881-5572
Practice Address - Street 1:335 EXT VISTAS DE CAMUY
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2937
Practice Address - Country:US
Practice Address - Phone:787-235-7694
Practice Address - Fax:787-881-5572
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist