Basic Information
| Provider Information | |||||||||
| NPI: | 1972967701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORTIZO-HERNANDEZ | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | BEATRIZ | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 EILEEN WAY UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117915313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168555255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7300 DEL PRADO CIR S | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334333386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613923000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME141352 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.