Provider Demographics
NPI:1144776840
Name:CORDERO FONTANEZ, PRISCILA M (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILA
Middle Name:M
Last Name:CORDERO FONTANEZ
Suffix:
Gender:F
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:A28 SAN PEDRO ESTATES
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7639
Mailing Address - Country:US
Mailing Address - Phone:787-210-4322
Mailing Address - Fax:
Practice Address - Street 1:A28 SAN PEDRO ESTATES
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7639
Practice Address - Country:US
Practice Address - Phone:787-769-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151227207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine