Provider Demographics
NPI:1275571119
Name:CORTES, ALFREDO
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:CORTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CORTES
Other - Middle Name:PARAMEDIC
Other - Last Name:RESCUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:BOX 5000
Mailing Address - Street 2:SUITE 816
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-7005
Mailing Address - Country:US
Mailing Address - Phone:787-252-2068
Mailing Address - Fax:787-818-0429
Practice Address - Street 1:CARR # 2 KM 136.9
Practice Address - Street 2:BO CERRO GORDO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-252-2068
Practice Address - Fax:787-818-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB2883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50520OtherPREFERRED MEDICARE CHOICE
PR0054216Medicare PIN