Provider Demographics
NPI:1235610486
Name:CORTES ZENO, BRYAN R
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:R
Last Name:CORTES ZENO
Suffix:
Gender:M
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 158
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-0158
Mailing Address - Country:US
Mailing Address - Phone:787-408-3922
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 11105
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9651
Practice Address - Country:US
Practice Address - Phone:787-262-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10836183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician