Provider Demographics
NPI:1619983699
Name:CORTES, MAYRA III
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:CORTES
Suffix:III
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:U108 CALLE TRUMAN
Mailing Address - Street 2:URB JOSE MERCADO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-258-4598
Mailing Address - Fax:787-782-0630
Practice Address - Street 1:1320 AVE SAN ALFONSO
Practice Address - Street 2:SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3621
Practice Address - Country:US
Practice Address - Phone:787-782-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4578183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician