1578705455 NPI number — DR. JANICE ANGELA SANTOS CORTES M.D.

Table of content: DR. JANICE ANGELA SANTOS CORTES M.D. (NPI 1578705455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578705455 NPI number — DR. JANICE ANGELA SANTOS CORTES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS CORTES
Provider First Name:
JANICE
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578705455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 ELLENFIELD ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905-4513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-444-6779
Provider Business Mailing Address Fax Number:
401-444-6912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 COLLYER STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-276-2002
Provider Business Practice Location Address Fax Number:
401-272-9299
Provider Enumeration Date:
03/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD15155 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112207200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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