Healthcare Provider Details

I. General information

NPI: 1013835768
Provider Name (Legal Business Name): CHRISTIAN ALEXIS PORTALATIN CORDERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 CALLE 12 NW # TH
SAN JUAN PR
00920-2233
US

IV. Provider business mailing address

1357 CALLE 12 NW # TH
SAN JUAN PR
00920-2233
US

V. Phone/Fax

Practice location:
  • Phone: 787-457-0388
  • Fax:
Mailing address:
  • Phone: 787-457-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62422
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6886
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: