Provider Demographics
NPI:1982022802
Name:CORTINA, ROSE EVLYNN (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:EVLYNN
Last Name:CORTINA
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:956-292-4554
Mailing Address - Fax:
Practice Address - Street 1:205 W WINDCREST ST STE 130
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4478
Practice Address - Country:US
Practice Address - Phone:830-990-1404
Practice Address - Fax:830-992-2871
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7410207XX0004X, 207XX0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program