Provider Demographics
NPI:1174145700
Name:LOPEZ CORTES, AUDAY (PA)
Entity type:Individual
Prefix:
First Name:AUDAY
Middle Name:
Last Name:LOPEZ CORTES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LINCOLN
Mailing Address - Street 2:JARDINES DE CASABLANCA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-222-2305
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE MARGINAL # C
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5552
Practice Address - Country:US
Practice Address - Phone:787-780-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR464-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant