MEDICARE: LOURDES FRANCESCA CORDERO MED, PSYD

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	390200000X	Student in an Organized Health Care Education/Training Program	PROCESS
2	103TC0700X	Clinical Psychologist	006759	PR

General Provider Information

NPI Number	:	1730657479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES FRANCESCA CORDERO MED, PSYD

Provider Business Mailing Address
First Line	:	914 CALLE ZARAGOZA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-4013
Country	:	US
Telephone Number	:	787-702-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 CALLE ZARAGOZA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-4013
Country	:	US
Telephone Number	:	787-702-4677
Fax Number	:

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

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	01/29/2024

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