Provider Demographics
NPI:1619003464
Name:CORTES MOLINA, HERALDA (LND)
Entity Type:Individual
Prefix:
First Name:HERALDA
Middle Name:
Last Name:CORTES MOLINA
Suffix:
Gender:F
Credentials:LND
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 800350
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0350
Mailing Address - Country:US
Mailing Address - Phone:787-342-2550
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1657
Practice Address - Country:US
Practice Address - Phone:787-342-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1447133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist