Provider Demographics
NPI:1245585231
Name:CORTES BADILLO, ARIEL (PH D)
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:
Last Name:CORTES BADILLO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 4444 KM 0.9
Mailing Address - Street 2:HC 05 BOX 10139
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-202-6967
Mailing Address - Fax:
Practice Address - Street 1:HC 5 BOX 10139
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9702
Practice Address - Country:US
Practice Address - Phone:787-202-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4252103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4252Medicaid
PR4252Medicaid
PR4252Medicare PIN