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General NPI Number Information
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NPI Number | 1194463372
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Entity Type | Individual
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Provider Name | CESAR LEONEL IBAN-CORDERO
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Gender | Male
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | AVE. PRINCIPAL BARALT G-24
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-863-7008
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Fax |
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Provider Business Mailing Address
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Address Line | URB. MONTE BRISAS ST. F-J16
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-206-0150
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6798
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License Number State | PR
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