Provider Demographics
NPI:1043829385
Name:CORTES, MAILYN (CRDH)
Entity type:Individual
Prefix:
First Name:MAILYN
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:MRS
Other - First Name:MAILYN
Other - Middle Name:
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1134 SW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-5418
Mailing Address - Country:US
Mailing Address - Phone:786-970-3712
Mailing Address - Fax:
Practice Address - Street 1:1134 SW 12TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-5418
Practice Address - Country:US
Practice Address - Phone:786-970-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH25725124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist