Provider Demographics
NPI:1497409395
Name:CORTES, ISABELLA MARIA
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MARIA
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 1:3746 72ND ST APT 4N
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6166
Mailing Address - Country:US
Mailing Address - Phone:407-580-6570
Mailing Address - Fax:
Practice Address - Street 1:15 METROTECH CTR STE 7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3856
Practice Address - Country:US
Practice Address - Phone:347-268-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program