Healthcare Provider Details

I. General information

NPI: 1265961650
Provider Name (Legal Business Name): HECTOR ALEJANDRO OLIVERAS CORDERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV AMERICO MIRANDA S/N SAN JUAN 00935
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

244 CALLE BROMELIAS URB. SAN RAFAEL ESTATES
BAYAMON PR
00959-4171
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15236
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15236
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: