Provider Demographics
NPI:1033937974
Name:CORTES MEDINA, YALITZA MARIE I (DMD)
Entity type:Individual
Prefix:DR
First Name:YALITZA
Middle Name:MARIE
Last Name:CORTES MEDINA
Suffix:I
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B18 CALLE 4
Mailing Address - Street 2:URB EL RETIRO
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1606
Mailing Address - Country:US
Mailing Address - Phone:910-644-3635
Mailing Address - Fax:
Practice Address - Street 1:CALLE RAFOLS ESQUINA DEL CARMEN
Practice Address - Street 2:#116
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-897-2727
Practice Address - Fax:787-895-1540
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist