=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316104748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. DELFIN GINES CORDOVA & ASSOC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VILLA CAROLINA AVE CAMPO RICO BLQ 204 #1 5TA SECCION
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-750-3390
-----------------------------------------------------
Fax | 787-750-3390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 92
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00986-0092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-750-3390
-----------------------------------------------------
Fax | 757-750-3390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DELFIN GINES MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-750-3390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number | 7628
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------