Provider Demographics
NPI:1538859376
Name:CORTES RODRIGUEZ, EZEQUIEL (BSN)
Entity type:Individual
Prefix:MR
First Name:EZEQUIEL
Middle Name:
Last Name:CORTES RODRIGUEZ
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CALLE SANTA ROSA
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5729
Mailing Address - Country:US
Mailing Address - Phone:787-247-0154
Mailing Address - Fax:
Practice Address - Street 1:210 CALLE SANTA ROSA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5729
Practice Address - Country:US
Practice Address - Phone:787-247-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR85798163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse