Healthcare Provider Details

I. General information

NPI: 1679557474
Provider Name (Legal Business Name): ANA CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE SUITE 504
SANTURCE PR
00912-3310
US

IV. Provider business mailing address

252 CALLE SAN JORGE
SAN JUAN PR
00912-3239
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-1575
  • Fax: 787-726-0402
Mailing address:
  • Phone: 787-728-1575
  • Fax: 787-726-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number012902
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number12902
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: