Provider Demographics
NPI:1083220198
Name:CORDOVA AMADOR, PEDRO RAFAEL SR (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:RAFAEL
Last Name:CORDOVA AMADOR
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 CHALETS DE LA PLAYA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-9748
Mailing Address - Country:US
Mailing Address - Phone:787-975-6000
Mailing Address - Fax:787-699-6176
Practice Address - Street 1:PR- 111 KM 14.6, BO. HATO ARRIBA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:939-699-6177
Practice Address - Fax:939-699-6176
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22006208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice