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General NPI Number Information
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NPI Number | 1083220198
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Entity Type | Individual
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Provider Name | PEDRO RAFAEL CORDOVA AMADOR SR. MD
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Gender | Male
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 02/10/2024
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Provider Practice Location Address
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Address Line | PR- 111 KM 14.6, BO. HATO ARRIBA
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 939-699-6177
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Fax | 939-699-6176
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Provider Business Mailing Address
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Address Line | 148 CHALETS DE LA PLAYA
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City | VEGA BAJA
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State | PR
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Zip | 00693-9748
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Country | US
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Telephone | 787-975-6000
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Fax | 787-699-6176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 22006
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License Number State | PR
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