MEDICARE: DR. SAUL CORDERO-CALERO M.D.

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	2085R0202X	Diagnostic Radiology Physician	13,022	PR
2	2085N0700X	Neuroradiology Physician	13,022	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13,022	OTHER	PR	PUERTO RICO MEDICAL LICENCE
2	DM 13121-9	OTHER	PR	AMSSCA

General Provider Information

NPI Number	:	1275619157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAUL CORDERO-CALERO M.D.

Provider Business Mailing Address
First Line	:	P. O. BOX 123
Second Line	:
City	:	ISABELA
State	:	PR
Zip	:	00662-0123
Country	:	US
Telephone Number	:	787-854-3131
Fax Number	:	787-854-3235

Provider Business Practice Location Address
First Line	:	C/MARGINAL ELLIOT VELEZ , ESQ. HERNANDEZ URB. ATENAS
Second Line	:	CENTRO RADIOLOGICO Y SONOGRAFICO DE MANATI
City	:	MANATI
State	:	PR
Zip	:	00674-0000
Country	:	US
Telephone Number	:	787-854-3131
Fax Number	:	787-854-3235

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	03/07/2023

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