Provider Demographics
NPI:1497845937
Name:CORTEZ, LEONARDO ACOSTA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:ACOSTA
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:MD
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 1969
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1969
Mailing Address - Country:US
Mailing Address - Phone:808-326-1944
Mailing Address - Fax:808-326-7103
Practice Address - Street 1:76-6225 KUAKINI HWY
Practice Address - Street 2:SUITE A107
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3211
Practice Address - Country:US
Practice Address - Phone:808-326-1944
Practice Address - Fax:808-326-1584
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5554173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02116301Medicaid
HIH2344 3OtherHMSA
HI02116301Medicaid
HIC98401Medicare UPIN