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General NPI Number Information
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NPI Number | 1376530279
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Entity Type | Individual
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Provider Name | CARLOS A LADO-CORNEJO PHD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 06/04/2023
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Provider Practice Location Address
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Address Line | 54 CALLE TENERIFE
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City | MAYAGUEZ
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State | PR
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Zip | 00680-1462
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Country | US
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Telephone | 787-403-4259
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Fax | 787-841-4170
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Provider Business Mailing Address
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Address Line | PO BOX 2921
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City | MAYAGUEZ
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State | PR
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Zip | 00681-2921
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Country | US
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Telephone | 787-403-4259
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Fax | 787-841-4170
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 02334
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2334
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | PSY1507
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License Number State | NM
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