Healthcare Provider Details

I. General information

NPI: 1700740966
Provider Name (Legal Business Name): KIARA L CORDERO RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 EL DORADO CLB # 3201
VEGA ALTA PR
00692-8860
US

IV. Provider business mailing address

3201 EL DORADO CLB # 3201
VEGA ALTA PR
00692-8860
US

V. Phone/Fax

Practice location:
  • Phone: 939-218-3748
  • Fax:
Mailing address:
  • Phone: 939-218-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8684
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: