Provider Demographics
NPI:1821106790
Name:CORTES, CRISTINA N (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:N
Last Name:CORTES
Suffix:
Gender:F
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:P O BOX 250477
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604
Mailing Address - Country:US
Mailing Address - Phone:787-658-6306
Mailing Address - Fax:787-658-6308
Practice Address - Street 1:929 N US HIGHWAY 441 STE 603
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3003
Practice Address - Country:US
Practice Address - Phone:352-775-3565
Practice Address - Fax:352-633-3704
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18907207R00000X
FLME100745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40715Medicare UPIN
FLP00617944OtherRAILROAD MEDICARE
FL1883420OtherCIGNA HEALTHCARE
FL31118OtherBCBS OF FLORIDA
FL281105700Medicaid
FL2619204OtherUNITED HEALTHCARE
FL7558679OtherAETNA HEALTHCARE
I40715Medicare UPIN
FLAK822ZMedicare PIN