MEDICARE: YAZMIN CORDERO CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1349	PR

General Provider Information

NPI Number	:	1003773144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZMIN CORDERO CRUZ

Provider Business Mailing Address
First Line	:	2FQ3/73M, CALLE ACEROLA
Second Line	:
City	:	COTO LAURE, PONCE
State	:	PR
Zip	:	00780
Country	:	US
Telephone Number	:	787-848-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	B-3, CALLE 8
Second Line	:	URB LAS MARIAS
City	:	SALINAS
State	:	PR
Zip	:	00751-2403
Country	:	US
Telephone Number	:	787-674-3487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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