MEDICARE: DR. GLADYS JEANNETTE CORDOVA MD

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	207R00000X	Internal Medicine Physician	7306	PR

General Provider Information

NPI Number	:	1679685275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLADYS JEANNETTE CORDOVA MD

Provider Business Mailing Address
First Line	:	PO BOX 21321
Second Line	:	UPR STATION
City	:	SAN JUAN
State	:	PR
Zip	:	00931
Country	:	US
Telephone Number	:	787-760-2940
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARRETICA 844 #1741 PURPLE TREE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-760-2940
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/29/2013

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