Provider Demographics
NPI:1972967701
Name:CORTIZO-HERNANDEZ, JACQUELINE BEATRIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BEATRIZ
Last Name:CORTIZO-HERNANDEZ
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 1:150 EILEEN WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5313
Mailing Address - Country:US
Mailing Address - Phone:516-855-5255
Mailing Address - Fax:
Practice Address - Street 1:7300 DEL PRADO CIR S
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3386
Practice Address - Country:US
Practice Address - Phone:561-392-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141352208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation