Provider Demographics
NPI:1366507006
Name:CORTES, IVAN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:JOSE
Last Name:CORTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IVAN
Other - Middle Name:JOSE
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:38 CALLE CAPRI
Mailing Address - Street 2:PASEO LAS BRISAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5947
Mailing Address - Country:US
Mailing Address - Phone:787-748-0046
Mailing Address - Fax:787-287-2273
Practice Address - Street 1:44 CALLE CARAZO
Practice Address - Street 2:OFFICE 2B
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5603
Practice Address - Country:US
Practice Address - Phone:787-287-6545
Practice Address - Fax:787-287-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9935174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83236Medicare ID - Type UnspecifiedMEDICARE
PRF49432Medicare UPIN