MEDICARE: MRS. GUSTAVO CORDERO GARCIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	7556	PR

General Provider Information

NPI Number	:	1235123563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GUSTAVO CORDERO GARCIA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9420
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9420
Country	:	US
Telephone Number	:	787-736-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVENIDA MUNOZ RIVERA
Second Line	:	#7 NORTE
City	:	SAN LORENZO
State	:	PR
Zip	:	00754
Country	:	US
Telephone Number	:	787-736-2252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	05/26/2009

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