Healthcare Provider Details

I. General information

NPI: 1376757948
Provider Name (Legal Business Name): CORDERO & SEPULVEDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BETANCES ST.
AGUADILLA PR
00603
US

IV. Provider business mailing address

PO BOX 186
AGUADILLA PR
00605-0186
US

V. Phone/Fax

Practice location:
  • Phone: 787-891-3434
  • Fax: 787-891-3434
Mailing address:
  • Phone: 787-891-3434
  • Fax: 787-891-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number3277
License Number StatePR

VIII. Authorized Official

Name: DR. DOMINGO CORDERO-RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-891-3434