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General NPI Number Information
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NPI Number | 1538343306
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Entity Type | Individual
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Provider Name | IDA REGINA CORDERO M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | URB. BRASILIA CALLE 4 C-8
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-654-6303
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3085
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City | VEGA ALTA
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State | PR
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Zip | 00692-3085
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Country | US
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Telephone | 787-654-6303
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 16,991
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License Number State | PR
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