Healthcare Provider Details

I. General information

NPI: 1043665631
Provider Name (Legal Business Name): JUAN MANUEL CORCHADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 494 KM 1 HE 1 BO ARENALES ALTOS
ISABELA PR
00662
US

IV. Provider business mailing address

PO BOX 662
ISABELA PR
00662-0662
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-6281
  • Fax:
Mailing address:
  • Phone: 787-872-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number19667
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: