Provider Demographics
NPI:1114053576
Name:CORDERO, NILSA
Entity Type:Individual
Prefix:MISS
First Name:NILSA
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 61711
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9029
Mailing Address - Country:US
Mailing Address - Phone:787-262-2253
Mailing Address - Fax:
Practice Address - Street 1:HC 6 BOX 61400
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9022
Practice Address - Country:US
Practice Address - Phone:787-820-2148
Practice Address - Fax:787-820-8181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2008043183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician