Provider Demographics
NPI:1043277726
Name:CORDERO PUPO, JULIO CESAR (MEDICINE DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CESAR
Last Name:CORDERO PUPO
Suffix:
Gender:M
Credentials:MEDICINE DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F3 CALLE F URB. SAN CARLOS
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-997-1896
Mailing Address - Fax:787-868-1515
Practice Address - Street 1:CARR 115 URB. FLAMBOYANES #6
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-688-1515
Practice Address - Fax:787-868-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13899208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH81009Medicare UPIN
PR20766Medicare ID - Type Unspecified