Provider Demographics
NPI:1639151616
Name:CORTES-MAISONET, GREGORIO A (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORIO
Middle Name:A
Last Name:CORTES-MAISONET
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 13867
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3867
Mailing Address - Country:US
Mailing Address - Phone:787-726-8396
Mailing Address - Fax:787-919-0640
Practice Address - Street 1:1826 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3004
Practice Address - Country:US
Practice Address - Phone:787-726-8396
Practice Address - Fax:787-919-0640
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16033208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice