Healthcare Provider Details

I. General information

NPI: 1144758814
Provider Name (Legal Business Name): ER SPECIALIZED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON
SAN JUAN PR
00917-5032
US

IV. Provider business mailing address

PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILFREDO JAVIER CORDERO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-642-2604