Provider Demographics
NPI:1396977781
Name:CORTES, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:CORTES
Suffix:
Gender:M
Credentials:
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 328
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0328
Mailing Address - Country:US
Mailing Address - Phone:787-868-1945
Mailing Address - Fax:787-868-1945
Practice Address - Street 1:AVE. NATIVO ALERS
Practice Address - Street 2:EDIFICIO PLAZA COOPELIA, #205, SEGUNDO PISO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-1945
Practice Address - Fax:787-868-1945
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical