Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 9062 | PR |
NPI | 1003993536 |
---|---|
Provider Name | Dr. Jose Antonio Cortes Santiago SR. |
First Address | Utuado, PR 00641-1836 |
Second Address | Utuado, PR 00641-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 01/03/2018 |