Healthcare Provider Details

I. General information

NPI: 1811870207
Provider Name (Legal Business Name): JUAN LUIS SANTIAGO CORDERO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PUBLICA & PR-2
VEGA BAJA PR
00693
US

IV. Provider business mailing address

393 VILLA BORINQUEN
LARES PR
00669-2807
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-3044
  • Fax: 787-855-3044
Mailing address:
  • Phone: 939-380-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number43249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: