1134190655 NPI number — JULIO D CORDERO

Table of content: JULIO D CORDERO (NPI 1134190655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134190655 NPI number — JULIO D CORDERO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDERO
Provider First Name:
JULIO
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134190655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. VEREDAS
Provider Second Line Business Mailing Address:
VEREDAS DE LOS CEDROS 698
Provider Business Mailing Address City Name:
GURABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00778-6098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-743-1985
Provider Business Mailing Address Fax Number:
787-744-6276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 931 KM 5.4
Provider Second Line Business Practice Location Address:
BO. NAVARRO SECTOR CIELITO
Provider Business Practice Location Address City Name:
GURABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-743-1985
Provider Business Practice Location Address Fax Number:
787-744-6276
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  16022 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16022 . This is a "LICENCIA" identifier . This identifiers is of the category "OTHER".




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